Provider Demographics
NPI:1679654560
Name:MITCHELL D. SHIKOFF, D.P.M.
Entity Type:Organization
Organization Name:MITCHELL D. SHIKOFF, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-638-4340
Mailing Address - Street 1:5000 BENSALEM BLVD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4043
Mailing Address - Country:US
Mailing Address - Phone:215-638-4446
Mailing Address - Fax:215-638-4447
Practice Address - Street 1:5000 BENSALEM BLVD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4043
Practice Address - Country:US
Practice Address - Phone:215-638-4446
Practice Address - Fax:215-638-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1616230OtherBS
PA2315834000OtherIBC
PA0990080Medicaid
PA1616230OtherBS
PA449587Medicare PIN
PAT30502Medicare UPIN
PA3856920001Medicare NSC