Healthcare Provider Details

I. General information

NPI: 1023050754
Provider Name (Legal Business Name): ARNOLD A FIKKERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17218 PRESTON RD STE 2000
DALLAS TX
75252-4018
US

IV. Provider business mailing address

PO BOX 742712
ATLANTA GA
30374-2712
US

V. Phone/Fax

Practice location:
  • Phone: 877-866-7123
  • Fax:
Mailing address:
  • Phone: 877-866-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL4370
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL4370
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: