Provider Demographics
NPI:1043279474
Name:LIKA, LARRY G (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:G
Last Name:LIKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:440-842-1570
Mailing Address - Fax:440-842-8230
Practice Address - Street 1:15299 BAGLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4823
Practice Address - Country:US
Practice Address - Phone:440-885-2100
Practice Address - Fax:440-885-2106
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4797207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00380959OtherRAILROAD MEDICARE
20021579OtherRAILROAD MEDICARE
OHP00760393OtherRAILROAD MEDICARE
OH0893001Medicaid
OH0875237Medicare PIN
OH0875233Medicare PIN
OH0875238Medicare PIN
OHP00380959OtherRAILROAD MEDICARE
OH0875234Medicare PIN