MEDICARE: KEVIN ANDREW HICKS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	23433	NH
2	207RR0500X	Rheumatology Physician	0101238458	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427106624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ANDREW HICKS M.D.

Provider Business Mailing Address
First Line	:	300A TEMPLE LAKE DR
Second Line	:	SUITE 1
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2972
Country	:	US
Telephone Number	:	804-524-2400
Fax Number	:	804-526-1852

Provider Business Practice Location Address
First Line	:	300A TEMPLE LAKE DR
Second Line	:	SUITE 1
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2972
Country	:	US
Telephone Number	:	804-524-2400
Fax Number	:	804-526-1852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	10/31/2023

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