Doctor Name: | DR. JEREMY MICHAEL SIKORA |
NPI Number: | 1679667828 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 35.088029 |
Business Practice Address: | 4881 Sugar Maple Dr 88 Mdos/sgoma Dayton, OH - 454335529 |
Business Phone Number: | 9372571684 |
Business Fax Number: | 9372571634 |
Mailing Address: | 4881 Sugar Maple Dr, 88 Mdos/sgoma DAYTON |
State: | OH |
Postal Code: | 454335529 |
Phone Number: | 9372571684 |
Fax Number: | 9372571634 |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 08/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 35.088029 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |