Provider Demographics
NPI:1245645282
Name:HICKLING, DAVID ROBERT (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:HICKLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36385 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2958
Mailing Address - Country:US
Mailing Address - Phone:586-684-1900
Mailing Address - Fax:586-684-1999
Practice Address - Street 1:36385 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2958
Practice Address - Country:US
Practice Address - Phone:586-684-1900
Practice Address - Fax:586-684-1999
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020970204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine