Provider Demographics
NPI:1992813406
Name:AMIRIKIA, KATHRYN CAROLIN (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:CAROLIN
Last Name:AMIRIKIA
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ALICE
Other - Last Name:CAROLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:1737 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-932-0315
Mailing Address - Fax:916-932-0003
Practice Address - Street 1:1737 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-932-0315
Practice Address - Fax:916-932-0312
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061506208600000X
CAG869192086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943235612OtherPEN MILLS SURG SPEC GRP
MI2612952Medicaid
MI383064919OtherUNIV SURGEONS TAX ID