Individual
SUSAN L HICKENBOTTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5333 MCAULEY DR, SUITE 6109, YPSILANTI, MI 48197-1014
(734) 712-1400
(734) 712-1670
Mailing address
24 FRANK LLOYD WRIGHT DR, PO BOX 0446 LOBBY J, ANN ARBOR, MI 48105-9484
(734) 747-6766
(734) 222-3100
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
4301061696
MI
2084N0400X
Neurology Physician
Primary
4301061696
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3473559
—
MI
Enumeration date
05/08/2006
Last updated
01/06/2025
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