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General NPI Number Information
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NPI Number | 1700986965
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Entity Type | Individual
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Provider Name | THOMAS GLENN HICKS MD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 601 JOHN ST BOX 42
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-341-6417
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Fax | 269-341-8743
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Provider Business Mailing Address
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Address Line | 680 COLUMBIA AVE W
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City | BATTLE CREEK
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State | MI
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Zip | 49015-3028
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Country | US
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Telephone | 269-965-4500
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Fax | 269-965-1150
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301035006
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License Number State | MI
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