Healthcare Provider Details

I. General information

NPI: 1427063114
Provider Name (Legal Business Name): MICHAEL J. KWIKER D.O. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 ALTA ARDEN EXPY SUITE 3
SACRAMENTO CA
95825-2121
US

IV. Provider business mailing address

3301 ALTA ARDEN EXPY SUITE 3
SACRAMENTO CA
95825-2121
US

V. Phone/Fax

Practice location:
  • Phone: 916-489-4400
  • Fax:
Mailing address:
  • Phone: 916-489-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberCA#20A-3637
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL J. KWIKER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 916-489-4400