Provider Demographics
NPI:1407918865
Name:FIKES, LINDA F (MD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:F
Last Name:FIKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:F
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2823 N GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210
Mailing Address - Country:US
Mailing Address - Phone:414-873-2993
Mailing Address - Fax:
Practice Address - Street 1:1555 SO LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-385-6600
Practice Address - Fax:414-385-6612
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B52513Medicare UPIN