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General NPI Number Information
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NPI Number | 1063480499
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Entity Type | Individual
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Provider Name | MARK G HICKEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 950 SPRUCE ST STE 1H
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City | LOUISVILLE
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State | CO
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Zip | 80027-1977
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Country | US
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Telephone | 720-598-1189
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Fax |
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Provider Business Mailing Address
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Address Line | 950 SPRUCE ST STE 1H
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City | LOUISVILLE
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State | CO
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Zip | 80027-1977
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Country | US
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Telephone | 720-625-8787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | DR-48317
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License Number State | CO
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