Provider Demographics
NPI:1134515489
Name:KIKAM, ADELINE (DO)
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:
Last Name:KIKAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 BUDDY OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6464
Mailing Address - Country:US
Mailing Address - Phone:956-971-0404
Mailing Address - Fax:956-971-0408
Practice Address - Street 1:1111 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3323
Practice Address - Country:US
Practice Address - Phone:419-502-2800
Practice Address - Fax:419-502-2821
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0266207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology