Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DS023115L | PA |
N | 1223G0001X | General Practice | DS023115L | PA |
N | 213EG0000X | General Practice | DS023115L | PA |
NPI | 1528272895 |
---|---|
Provider Name | Jeffrey Michael Fike |
First Address | Harrisburg, PA 17112-3805 |
Second Address | Harrisburg, PA 17112-3805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009270590001 | (05) | PA |