Provider Demographics
NPI:1316922065
Name:SIKKINK, JEFFREY LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LLOYD
Last Name:SIKKINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15290 PENNOCK LN
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7163
Practice Address - Country:US
Practice Address - Phone:952-853-8800
Practice Address - Fax:952-431-6966
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35839207Q00000X
WI29105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31398200Medicaid
MN575268000Medicaid
WI31398200Medicaid
MNA02099Medicare UPIN
MN080013992Medicare PIN
WI001356150Medicare PIN