Basic Information
| Provider Information | |||||||||
| NPI: | 1760708572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIKORSKA | ||||||||
| FirstName: | MIROSLAWA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 MEDICAL CIR | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067805330 | ||||||||
| FaxNumber: | 6067802380 | ||||||||
| Practice Location | |||||||||
| Address1: | 716 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067805364 | ||||||||
| FaxNumber: | 6067802380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 06/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 43457 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 43457 | 01 | KY | LICENSE | OTHER | 7100111900 | 05 | KY | MEDICAID |