Provider Demographics
NPI:1083999486
Name:PIKAL PLC
Entity Type:Organization
Organization Name:PIKAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PIKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-674-3502
Mailing Address - Street 1:3775 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3949
Mailing Address - Country:US
Mailing Address - Phone:248-674-3502
Mailing Address - Fax:
Practice Address - Street 1:1695 W 12 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2182
Practice Address - Country:US
Practice Address - Phone:248-674-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP064302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5174Medicare PIN
MIG59425Medicare UPIN
MI0N14110Medicare PIN