Provider Demographics
NPI:1629043930
Name:SIKORSKI, CHRISTIAN W (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:W
Last Name:SIKORSKI
Suffix:
Gender:M
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:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12266 DE PAUL DR STE 100
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2541
Practice Address - Country:US
Practice Address - Phone:314-738-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087045207T00000X
IN01082618A207T00000X
MO20100093266207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252000123OtherMEDICARE
MI0111095OtherBLUE CROSS BLUE SHIELD
MI104938622Medicaid
OP32880OtherRR MEDICARE
IN300032360Medicaid