Provider Demographics
NPI:1174729487
Name:HICKEY, MIKE J (ATC,CSCS)
Entity type:Individual
Prefix:MR
First Name:MIKE
Middle Name:J
Last Name:HICKEY
Suffix:
Gender:M
Credentials:ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 CUNAT CT APT 1B
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6159
Mailing Address - Country:US
Mailing Address - Phone:708-308-4734
Mailing Address - Fax:
Practice Address - Street 1:1415 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1870
Practice Address - Country:US
Practice Address - Phone:630-705-1950
Practice Address - Fax:630-705-1980
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer