Provider Demographics
NPI:1356342125
Name:HICKS, LEE G (MD)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:G
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUITE #701
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-276-0414
Practice Address - Fax:859-276-3765
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY30737207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64307374Medicaid
F80629Medicare UPIN
KY64307374Medicaid