Provider Demographics
NPI:1174521041
Name:HICKOX, TODD G (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:G
Last Name:HICKOX
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3301 E MICHIGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4641
Mailing Address - Country:US
Mailing Address - Phone:517-253-3633
Mailing Address - Fax:517-253-6330
Practice Address - Street 1:1140 E MICHIGAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1806
Practice Address - Country:US
Practice Address - Phone:517-364-9650
Practice Address - Fax:517-364-9605
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2019-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008734207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2987950Medicaid
MIE95590Medicare UPIN
MIOC36345015Medicare ID - Type Unspecified