Provider Demographics
NPI:1205917028
Name:FIKSMAN, IRINA (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:FIKSMAN
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 1:31500 W 13 MILE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2164
Mailing Address - Country:US
Mailing Address - Phone:248-488-8700
Mailing Address - Fax:
Practice Address - Street 1:31500 W 13 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2164
Practice Address - Country:US
Practice Address - Phone:248-488-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0454752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2606320341OtherBLUE CROSS BLUE SHIELD
MI10 1742611Medicaid
MI1742611Medicaid
MI10 1742611Medicaid
MI1742611Medicaid