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General NPI Number Information
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NPI Number | 1982959235
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Entity Type | Individual
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Provider Name | ELIZABETH SHOKOUI HICKS D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 827 E DIVISION ST
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City | CADILLAC
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State | MI
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Zip | 49601-2015
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Country | US
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Telephone | 231-775-9741
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE MC 845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL1597
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License Number State | SC
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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 | 5101021221
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License Number State | MI
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