Individual
MICHAEL J HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4000 ROUTE 130 BLDG C, DELRAN, NJ 08075-2414
(856) 705-0685
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD023250E
PA
207Q00000X
Family Medicine Physician
Primary
25MA09803100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008913770010
—
PA
Enumeration date
08/11/2005
Last updated
02/09/2022
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