Individual
RONALD ANTHONY HICKOMBOTTOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4009 N BROADWAY ST, CHICAGO, IL 60613-2110
(773) 275-2586
Mailing address
4009 N BROADWAY ST, CHICAGO, IL 60613-2110
(773) 275-2586
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.065509
IL
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
036065509
IL
Other
Enumeration date
08/12/2006
Last updated
02/27/2026
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