Individual
MARY HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5200 DTC PKWY, SUITE 400, GREENWOOD VILLAGE, CO 80111-2709
(303) 745-0000
(303) 708-1834
Mailing address
5200 DTC PKWY, SUITE 400, GREENWOOD VILLAGE, CO 80111-2709
(303) 745-0000
(303) 708-1834
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036112109
IL
207R00000X
Internal Medicine Physician
45326
CO
208M00000X
Hospitalist Physician
Primary
45326
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361121092
—
IL
01
—
105682
HEALTH ALLIANCE
IL
05
—
46379576
—
CO
01
—
623665
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
IL01V7
JOHN DEERE
IL
01
—
P00281865
RAILROAD MEDICARE
IL
Enumeration date
07/31/2006
Last updated
05/10/2019
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