Provider Demographics
NPI:1144404708
Name:DKS MEDICAL ASSOCIATES,PC
Entity Type:Organization
Organization Name:DKS MEDICAL ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:STRICKLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-878-7100
Mailing Address - Street 1:5201 WYNNEFIELD AVE
Mailing Address - Street 2:SUITE G4
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2456
Mailing Address - Country:US
Mailing Address - Phone:215-878-7100
Mailing Address - Fax:215-878-1871
Practice Address - Street 1:5201 WYNNEFIELD AVE
Practice Address - Street 2:SUITE G4
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-2456
Practice Address - Country:US
Practice Address - Phone:215-878-7100
Practice Address - Fax:215-878-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049630-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063576Medicare PIN