Basic Information
| Provider Information | |||||||||
| NPI: | 1407434194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIKUS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 WESTLAKE HILLS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472011105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123754183 | ||||||||
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| Practice Location | |||||||||
| Address1: | CMC/DEPARTMENT OF EMERGENCY MEDICINE | ||||||||
| Address2: | 1000 BLYTHE BLVD | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043553181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2021 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.