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General NPI Number Information
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NPI Number | 1184354169
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Entity Type | Individual
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Provider Name | KAMAAL ABDUL-RAHEEM HICKS MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2 MEMORIAL DR STE 220
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City | ALTON
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State | IL
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Zip | 62002-6723
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Country | US
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Telephone | 618-474-1723
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Fax | 618-433-6299
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Provider Business Mailing Address
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Address Line | PO BOX 959203
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City | SAINT LOUIS
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State | MO
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Zip | 63195-9203
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Country | US
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Telephone | 618-474-1723
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Fax | 618-433-6299
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036173538
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.173538
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License Number State | IL
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