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General NPI Number Information
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NPI Number | 1629392352
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Entity Type | Individual
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Provider Name | SERGEY SHIKANOV M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE MC 6038
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-0173
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Fax | 773-702-1001
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Provider Business Mailing Address
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Address Line | 1709 PONTIAC TRL
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City | ANN ARBOR
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State | MI
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Zip | 48105-1722
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Country | US
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Telephone | 505-205-0076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD2011-0421
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301101038
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 036128545
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License Number State | IL
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