Provider Demographics
NPI:1366788226
Name:DANIELLE KIKO MD LLC
Entity type:Organization
Organization Name:DANIELLE KIKO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-956-5300
Mailing Address - Street 1:128 WERTZ AVE NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4196
Mailing Address - Country:US
Mailing Address - Phone:330-956-5300
Mailing Address - Fax:330-956-5318
Practice Address - Street 1:128 WERTZ AVE NW
Practice Address - Street 2:SUITE B
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4196
Practice Address - Country:US
Practice Address - Phone:330-206-2387
Practice Address - Fax:330-956-5318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty