Healthcare Provider Details

I. General information

NPI: 1952774036
Provider Name (Legal Business Name): PAUL HILLIKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD
WARREN MI
48093
US

IV. Provider business mailing address

28334 FLANDERS AVE
WARREN MI
48088-4373
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5000
  • Fax:
Mailing address:
  • Phone: 248-892-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704276686
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: