Basic Information
Provider Information | |||||||||
NPI: | 1942233432 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SIKKINK | ||||||||
FirstName: | KARI | ||||||||
MiddleName: | R N | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8170 33RD AVE S # MS 21110Q | ||||||||
Address2: |   | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 554254516 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1500 CURVE CREST BLVD W | ||||||||
Address2: |   | ||||||||
City: | STILLWATER | ||||||||
State: | MN | ||||||||
PostalCode: | 550826040 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6514391234 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2006 | ||||||||
LastUpdateDate: | 05/24/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/24/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 33648 | MN | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 12965 | 05 | ND |   | MEDICAID | 37654 | 01 | ND | SIOUX VALLEY # | OTHER | 870277200 | 05 | ND |   | MEDICAID | 28953 | 01 | ND | LHS # | OTHER | 6606472 | 01 | ND | MEDICA UC-INN # | OTHER | 74G11SI | 01 | ND | MNBS FGO # | OTHER | DA9011031056 | 01 | ND | PREF 1 # | OTHER | HP40870 | 01 | ND | HEALTHPARTNERS # | OTHER | 762753 | 01 | ND | ARAZ # | OTHER | 0116762 | 01 | ND | MEDICA FGO # | OTHER | 24079 | 01 | ND | NDBS # | OTHER | 137100 | 01 | ND | UCARE # | OTHER |