Provider Demographics
NPI:1225066251
Name:KIKTA, DONALD GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GREGORY
Last Name:KIKTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6681 RIDGE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5713
Mailing Address - Country:US
Mailing Address - Phone:440-884-1166
Mailing Address - Fax:440-884-1150
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-884-1166
Practice Address - Fax:440-884-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350397672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0427587Medicaid
OHDO0882381Medicare ID - Type Unspecified
OH0427587Medicaid