Provider Demographics
NPI:1285688101
Name:LUIKENAAR, RIXT ANNA CATHARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:RIXT
Middle Name:ANNA CATHARINA
Last Name:LUIKENAAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 E 4500 S STE 265
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4024
Mailing Address - Country:US
Mailing Address - Phone:801-272-3909
Mailing Address - Fax:801-272-3902
Practice Address - Street 1:2180 E 4500 S STE 265
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4024
Practice Address - Country:US
Practice Address - Phone:801-272-3909
Practice Address - Fax:801-272-3902
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53099731205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107022141101OtherIHC GRP 22
UT121269900Medicaid
UT97977OtherU HEALTH PLANS
UT813565OtherDMBA
UTTPRA07450OtherMOLINA GRP 22
UTD5070Medicaid
UT378821200OtherDOL GRP 22
UT73582OtherPEHP GRP 22
UTQM0000068194OtherALTIUS
UT53099731201001OtherBCBS GRP 22
UT870616107RLUOtherEMIA GRP 22
UTQM0000068194OtherALTIUS
UTH88799Medicare UPIN