Provider Demographics
NPI:1760708572
Name:SIKORSKA, MIROSLAWA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAWA
Middle Name:E
Last Name:SIKORSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-780-5330
Mailing Address - Fax:606-780-2380
Practice Address - Street 1:716 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1444
Practice Address - Country:US
Practice Address - Phone:606-780-5364
Practice Address - Fax:606-780-2380
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43457208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43457OtherLICENSE
KY7100111900Medicaid
KY43457OtherLICENSE