Individual
MR. JASON T HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PCC
Contact information
Practice address
419 S CORAL ST, KALKASKA, MI 49646-2503
(231) 258-7500
(231) 258-7527
Mailing address
419 S CORAL ST, KALKASKA, MI 49646-2503
(231) 258-7500
(231) 258-7527
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601003956
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601003956
LICENSE
MI
Enumeration date
06/13/2005
Last updated
04/16/2021
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