MEDICARE: MRS. STACI CARYN SIKORA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1023225919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACI CARYN SIKORA DDS

Provider Business Mailing Address
First Line	:	141 W JACKSON BLVD
Second Line	:	SUITE 3632
City	:	CHICAGO
State	:	IL
Zip	:	60604-2929
Country	:	US
Telephone Number	:	312-939-2400
Fax Number	:	312-987-1535

Provider Business Practice Location Address
First Line	:	141 W JACKSON BLVD
Second Line	:	SUITE 3632
City	:	CHICAGO
State	:	IL
Zip	:	60604-2929
Country	:	US
Telephone Number	:	312-939-2400
Fax Number	:	312-987-1535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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