Provider Demographics
NPI:1972500031
Name:KIKEN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KIKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-2851
Mailing Address - Country:US
Mailing Address - Phone:434-947-5967
Mailing Address - Fax:434-947-5971
Practice Address - Street 1:1003 5TH ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-2851
Practice Address - Country:US
Practice Address - Phone:434-947-5967
Practice Address - Fax:434-947-5971
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057217207V00000X
WV21079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2004041000Medicaid
VA014035J79Medicare PIN
WVA41965Medicare UPIN
WV2023961Medicare ID - Type Unspecified