| Doctor Name: | STUART HICKERSON |
| NPI Number: | 1073629374 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 036083126 |
| Business Practice Address: | 12528 Sr 78 Havana, IL - 626446866 |
| Business Phone Number: | 3095434253 |
| Business Fax Number: | |
| Mailing Address: | 3333 N Seminary St, GALESBURG |
| State: | IL |
| Postal Code: | 614011251 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2006 |
| NPI Last Update Date: | 04/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207PE0004X |
| License Number: | 036083126 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Emergency Medicine |
| Taxonomy Specialization: | Emergency Medical Services |
| Taxonomy Definition: | An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |