Healthcare Provider Details

I. General information

NPI: 1568034775
Provider Name (Legal Business Name): I AM HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 FOREST ST
DOVER DE
19904-3401
US

IV. Provider business mailing address

59 IVY GLEN CT
SMYRNA DE
19977-4049
US

V. Phone/Fax

Practice location:
  • Phone: 302-643-3966
  • Fax: 302-643-3969
Mailing address:
  • Phone: 302-310-9369
  • Fax: 302-643-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARQUITA JOHNIKEN
Title or Position: OWNER
Credential:
Phone: 302-310-9369