Provider Demographics
NPI:1497823595
Name:DENIKE, MICHAEL R (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:DENIKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 BIRCHAVEN LANE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9746
Mailing Address - Country:US
Mailing Address - Phone:419-427-0357
Mailing Address - Fax:419-424-0513
Practice Address - Street 1:15110 BIRCHAVEN LANE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9746
Practice Address - Country:US
Practice Address - Phone:419-427-0357
Practice Address - Fax:419-424-0513
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMD014193207R00000X, 207RC0000X
OH34009295207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
060H211110OtherBCBS
MI482722011Medicaid
OHP00641175OtherRAILROAD MEDICARE
OH2853158Medicaid
I37043Medicare UPIN
OH2853158Medicaid
OH4242621Medicare PIN