Provider Demographics
NPI:1003112855
Name:SIKORA, WOJCIECH RYSZARD
Entity Type:Individual
Prefix:MR
First Name:WOJCIECH
Middle Name:RYSZARD
Last Name:SIKORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N MILFORD RD
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1058
Mailing Address - Country:US
Mailing Address - Phone:248-685-9623
Mailing Address - Fax:
Practice Address - Street 1:1550 N MILFORD RD
Practice Address - Street 2:SUITE 203B
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1058
Practice Address - Country:US
Practice Address - Phone:248-685-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002976225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant