Provider Demographics
NPI:1790784056
Name:SIKORSKI, LYNN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:SIKORSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0238
Mailing Address - Country:US
Mailing Address - Phone:248-338-6400
Mailing Address - Fax:248-338-2920
Practice Address - Street 1:1900 S TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0238
Practice Address - Country:US
Practice Address - Phone:248-338-6400
Practice Address - Fax:248-338-2920
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009963207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI44760OtherBLUE CARE NETWORK PROVID.
MI3319129Medicaid
MI0156301155OtherBCBSM INDIVIDUAL PIN
MIF34902Medicare UPIN
MI44760OtherBLUE CARE NETWORK PROVID.