Healthcare Provider Details

I. General information

NPI: 1457391005
Provider Name (Legal Business Name): GREGORY G HICKEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30575 BAINBRIDGE RD STE 200
CLEVELAND OH
44139-2275
US

IV. Provider business mailing address

30575 BAINBRIDGE RD STE 200
CLEVELAND OH
44139-2275
US

V. Phone/Fax

Practice location:
  • Phone: 440-542-5000
  • Fax: 440-542-5005
Mailing address:
  • Phone: 440-542-5000
  • Fax: 440-542-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34-003908
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number003908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: