Healthcare Provider Details

I. General information

NPI: 1457591471
Provider Name (Legal Business Name): SHAWN DOUGLAS HICKS M.D., MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 TERRACE ST 655 SCAIF HALL
PITTSBURGH PA
15213-2500
US

IV. Provider business mailing address

123 ECHO DR UNIT 207
OTTAWA ONTARIO
K1S 1M9
CA

V. Phone/Fax

Practice location:
  • Phone: 412-647-6249
  • Fax: 412-578-9340
Mailing address:
  • Phone: 613-233-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMT194194
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: