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Organization
JEFFREY J HICKS DPM PC
Active
Organization
JEFFREY J HICKS DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY J HICKS DPM PC (PRESIDENT)
(847) 336-3020
Entity
Organization
Contact information
Practice address
15 TOWER CT, STE 250, GURNEE, IL 60031
(847) 336-3020
(847) 336-3318
Mailing address
15 TOWER CT, STE 250, GURNEE, IL 60031
(847) 336-3020
(847) 336-3318
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004968
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004968
—
IL
01
—
04926843
BCBS
IL
01
—
4481570001
NATIONAL GOVERNMENT SERVICES
IL
01
—
DD4677
RAILROAD MEDICARE
IL
Enumeration date
01/20/2006
Last updated
01/04/2011
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