Healthcare Provider Details

I. General information

NPI: 1629392352
Provider Name (Legal Business Name): SERGEY SHIKANOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

IV. Provider business mailing address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax:
Mailing address:
  • Phone: 269-966-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036128545
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD2011-0421
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301101038
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: