Provider Demographics
NPI:1306256649
Name:SIKORSKI, AMBER NICHOLE (DO)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:SIKORSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICHOLE
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35054 23 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2019
Mailing Address - Country:US
Mailing Address - Phone:586-725-2670
Mailing Address - Fax:586-725-3347
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:PB2 STE 70
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-3800
Practice Address - Fax:313-343-4756
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021071390200000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program