Provider Demographics
NPI:1952520736
Name:SIKKENGA, ERICKA SHANNON (DO)
Entity Type:Individual
Prefix:DR
First Name:ERICKA
Middle Name:SHANNON
Last Name:SIKKENGA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ERICKA
Other - Middle Name:SHANNON
Other - Last Name:KIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-5211
Mailing Address - Fax:231-727-4571
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 428
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-672-3300
Practice Address - Fax:231-672-3380
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N27530OtherMEDICARE GROUP NUMBER