Provider Demographics
NPI:1346236353
Name:HICK, ERIC JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAMES
Last Name:HICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7910 W JEFFERSON BLVD STE 205B
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-0072
Practice Address - Country:US
Practice Address - Phone:260-458-3460
Practice Address - Fax:260-458-3461
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002309A208800000X
SD13230208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology