1891815536 NPI number — LYNN M. SIKORSKI, D.O., P.C.

Table of content: (NPI 1891815536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891815536 NPI number — LYNN M. SIKORSKI, D.O., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYNN M. SIKORSKI, D.O., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891815536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 82154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48308-2154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-338-6400
Provider Business Mailing Address Fax Number:
248-338-2920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-0238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-338-6400
Provider Business Practice Location Address Fax Number:
248-338-2920
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIKORSKI
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-338-6400

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  5101009963 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3319129 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5101009963 . This is a "PHYSICIAN LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0156301155 . This is a "BLUE CROSS IND. PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5630115 . This is a "BLUE CARE NETWORK PROVIDE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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