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General NPI Number Information
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NPI Number | 1861576142
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS HICKEY D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 14400 BEAR VALLEY RD
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City | VICTORVILLE
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State | CA
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Zip | 92392-5470
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Country | US
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Telephone | 760-951-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 53 SUNDANCE DR
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City | POMONA
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State | CA
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Zip | 91766-4874
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Country | US
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Telephone | 760-951-2000
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E2317
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License Number State | CA
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