Healthcare Provider Details

I. General information

NPI: 1043279474
Provider Name (Legal Business Name): LARRY G LIKA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15299 BAGLEY RD STE 100
CLEVELAND OH
44130-4823
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 440-885-2100
  • Fax: 440-885-2106
Mailing address:
  • Phone: 440-842-1570
  • Fax: 440-842-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34-00-4797
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: