Healthcare Provider Details
I. General information
NPI: 1285688101
Provider Name (Legal Business Name): RIXT ANNA CATHARINA LUIKENAAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 05/22/2006
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2180 E 4500 S STE 265
HOLLADAY UT
84117-4024
US
IV. Provider business mailing address
2180 E 4500 S STE 265
HOLLADAY UT
84117-4024
US
V. Phone/Fax
- Phone: 801-272-3909
- Fax: 801-272-3902
- Phone: 801-272-3909
- Fax: 801-272-3902
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | 53099731205 |
| License Number State | UT |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 107022141101 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | IHC GRP 22 |
| # 2 | |
| Identifier | 121269900 |
| Identifier Type | MEDICAID |
| Identifier State | UT |
| Identifier Issuer | |
| # 3 | |
| Identifier | 97977 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | U HEALTH PLANS |
| # 4 | |
| Identifier | 813565 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | DMBA |
| # 5 | |
| Identifier | TPRA07450 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | MOLINA GRP 22 |
| # 6 | |
| Identifier | D5070 |
| Identifier Type | MEDICAID |
| Identifier State | UT |
| Identifier Issuer | |
| # 7 | |
| Identifier | 378821200 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | DOL GRP 22 |
| # 8 | |
| Identifier | 73582 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | PEHP GRP 22 |
| # 9 | |
| Identifier | QM0000068194 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | ALTIUS |
| # 10 | |
| Identifier | 53099731201001 |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | BCBS GRP 22 |
| # 11 | |
| Identifier | 870616107RLU |
| Identifier Type | OTHER |
| Identifier State | UT |
| Identifier Issuer | EMIA GRP 22 |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
