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General NPI Number Information
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NPI Number | 1760992663
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Entity Type | Individual
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Provider Name | CHAD A. HICKS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 2142 N COVE BLVD FL 1
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City | TOLEDO
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State | OH
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Zip | 43606-3895
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Country | US
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Telephone | 419-291-4000
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Fax | 419-479-3253
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Provider Business Mailing Address
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Address Line | 333 N SUMMIT ST FL 7
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City | TOLEDO
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State | OH
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Zip | 43604-1531
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Country | US
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Telephone | 419-291-2671
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Fax | 419-291-2680
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601008321
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.005399RX
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License Number State | OH
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