Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 19A15911 | IL |
NPI | 1013047448 |
---|---|
Provider Name | Richard L. Sikora |
First Address | Normal, IL 61761-2132 |
Second Address | Normal, IL 61761-2132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |