Provider Demographics
NPI:1154557999
Name:HICKMAN, MICHAEL OLIVER JR (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OLIVER
Last Name:HICKMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:STE 160W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7508
Mailing Address - Country:US
Mailing Address - Phone:406-237-5400
Mailing Address - Fax:406-237-5420
Practice Address - Street 1:2900 12TH AVE N STE 503E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7502
Practice Address - Country:US
Practice Address - Phone:406-233-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT57485208800000X
PAMD478563208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology