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NPI Code Detail

MEDICARE: ANNALISE J SIKMA

MEDICARE: ANNALISE J SIKMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6362009404MI

General Provider Information

NPI Number : 1811451339
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNALISE J SIKMA
Provider Business Mailing Address
First Line : 3809 LAKE EASTBROOK BLVD SE STE A
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-5931
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3809 LAKE EASTBROOK BLVD SE STE A
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-5931
Country : US
Telephone Number : 616-604-8492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2019
Last Update Date : 08/27/2021

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Directions to “ ANNALISE J SIKMA ” Practice Location

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