Provider Information for 1518017904
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MARK SIKORA
Sex: Male
NPI: 1518017904
Last Updated: 2014-02-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1518017904 | ||||||||||||
| Enumeration Date | 2007-01-10 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5107 BOULDER WAY YAKIMA, WA 98901-1618 United States Phone: 509-966-7953 | Fax: | ||||||||||||
| Primary Practice Address | 5107 BOULDER WAY YAKIMA, WA 98901-1618 United States Phone: 509-966-7953 | Fax: | ||||||||||||
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