MEDICARE: DR. TIMOTHY MICHAEL HICKEY 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	2084N0400X	Neurology Physician	35-084480	OH

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	:	1992708218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MICHAEL HICKEY M.D.

Provider Business Mailing Address
First Line	:	2019 WILDWOOD BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-4231
Country	:	US
Telephone Number	:	419-385-5793
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 NAVARRE AVE
Second Line	:	SUITE 102
City	:	OREGON
State	:	OH
Zip	:	43616-3275
Country	:	US
Telephone Number	:	419-690-8273
Fax Number	:	419-690-8308

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/30/2013

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