Provider Demographics
NPI:1982886826
Name:SIKORA, MAXCIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MAXCIE
Middle Name:MARIE
Last Name:SIKORA
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 1:971 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2803
Mailing Address - Country:US
Mailing Address - Phone:850-654-4641
Mailing Address - Fax:850-654-9295
Practice Address - Street 1:971 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2803
Practice Address - Country:US
Practice Address - Phone:850-654-4641
Practice Address - Fax:850-654-9295
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200817207K00000X
FL149180207KA0200X
LAMD.2008172080P0201X
ALMD30044207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08836528Medicaid
FL114554000Medicaid
LA1079952Medicaid
LA4N2607061Medicare PIN