Provider Demographics
NPI:1942236120
Name:SHIKOFF, MITCHELL D (DPM)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:D
Last Name:SHIKOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002651L213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0990080Medicaid
PA1616230OtherBS
PA0023162000OtherIBC
PA0023162000OtherIBC
232328099OtherTIN
PAT30502Medicare UPIN
PA0023162000OtherIBC
PA0990080Medicaid