Individual
BENJAMIN MATTHEW HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01046509A
IN
207XX0801X
Orthopaedic Trauma Physician
Primary
01046509A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000089400
ANTHEM
—
01
—
200032481
RAILROAD MEDICARE
—
05
—
200089330A
—
IN
Enumeration date
05/23/2005
Last updated
11/03/2016
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