Individual
STUART HICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12528 SR 78, HAVANA, IL 62644-6866
(309) 543-4253
Mailing address
3333 N SEMINARY ST, GALESBURG, IL 61401-1251
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036083126
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036083126
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036083126
—
IL
Enumeration date
08/21/2006
Last updated
12/13/2024
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