# MICHIGAN MSK MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578148375
- **Authorized official:** DAVID R HICKLING DO (OWNER)
- **Authorized official phone:** (586) 684-1900

## Contact information

- **Practice address:** 36385 HARPER AVE, CLINTON TOWNSHIP, MI 48035-2958
- **Practice address phone:** (586) 684-1900
- **Practice address fax:** (586) 684-1999
- **Mailing address:** 36385 HARPER AVE, CLINTON TOWNSHIP, MI 48035-2958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | NULL | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | — | — |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 03/12/2021
- **Last updated:** 07/25/2023