Provider Demographics
NPI:1992708218
Name:HICKEY, TIMOTHY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:HICKEY
Suffix:
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 1:2019 WILDWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4231
Mailing Address - Country:US
Mailing Address - Phone:419-385-5793
Mailing Address - Fax:
Practice Address - Street 1:2735 NAVARRE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3275
Practice Address - Country:US
Practice Address - Phone:419-690-8273
Practice Address - Fax:419-690-8308
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0844802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2604408Medicaid