Provider Demographics
NPI:1396779591
Name:KIKANO, GEORGE E (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:KIKANO
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:CMU HEALTH SERVICES
Mailing Address - Street 2:202 FOUST HALL
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48859-0001
Mailing Address - Country:US
Mailing Address - Phone:989-774-1748
Mailing Address - Fax:
Practice Address - Street 1:CMU HEALTH SERVICES
Practice Address - Street 2:202 FOUST HALL
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-0001
Practice Address - Country:US
Practice Address - Phone:989-774-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-000294207Q00000X
MI4301107535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000135266OtherANTHEM
OH000000530390OtherANTHEM
000000224230OtherUNISON
OHP00425619OtherRAILROAD MEDICARE
363701OtherWELLCARE
737677OtherBUCKEYE
OH0838759Medicaid
OH635184OtherAETNA
OH80044870OtherRAILROAD MEDICARE
OHP00425619OtherRAILROAD MEDICARE
MI0G37620Medicare PIN
OH000000530390OtherANTHEM
OHKI0696275Medicare PIN