Provider Demographics
NPI:1144417445
Name:SIKORSKI, THEODORE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JOHN
Last Name:SIKORSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 S DEVON PARK PL
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7167
Mailing Address - Country:US
Mailing Address - Phone:504-669-7197
Mailing Address - Fax:
Practice Address - Street 1:850 JAKE ALEXANDER BLVD W
Practice Address - Street 2:SUITE G #148
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1225
Practice Address - Country:US
Practice Address - Phone:504-903-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC179921207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1505927Medicaid
NCNC6921JOtherMEDICARE PTAN
NCNC6921IOtherMEDICARE PTAN