1952520736 NPI number — DR. ERICKA SHANNON SIKKENGA D.O.

Table of content: LAUREN ALEXANDER BS (NPI 1346601622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952520736 NPI number — DR. ERICKA SHANNON SIKKENGA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIKKENGA
Provider First Name:
ERICKA
Provider Middle Name:
SHANNON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIPP
Provider Other First Name:
ERICKA
Provider Other Middle Name:
SHANNON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952520736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1847
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49443-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-727-5211
Provider Business Mailing Address Fax Number:
231-727-4571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 LEAHY ST
Provider Second Line Business Practice Location Address:
SUITE 428
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-672-3300
Provider Business Practice Location Address Fax Number:
231-672-3380
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  5101015950 , 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: 0N27530 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com