Provider Demographics
NPI:1538289186
Name:KWIKER, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KWIKER
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 1:3301 ALTA ARDEN EXPY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2121
Mailing Address - Country:US
Mailing Address - Phone:916-489-4400
Mailing Address - Fax:916-489-1710
Practice Address - Street 1:3301 ALTA ARDEN EXPY
Practice Address - Street 2:SUITE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2121
Practice Address - Country:US
Practice Address - Phone:916-489-4400
Practice Address - Fax:916-489-1710
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A-3637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89839Medicare UPIN
CAZZZ17757ZMedicare ID - Type Unspecified