Provider Demographics
NPI:1679667828
Name:SIKORA, JEREMY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:SIKORA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:88 MDOS/SGOMA
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-257-1684
Mailing Address - Fax:937-257-1634
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:88 MDOS/SGOMA
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-1684
Practice Address - Fax:937-257-1634
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.088029208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice