Provider Demographics
NPI:1437143153
Name:SIKOSKI, PETER JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:SIKOSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3884
Mailing Address - Country:US
Mailing Address - Phone:406-587-3788
Mailing Address - Fax:406-587-3922
Practice Address - Street 1:1104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3884
Practice Address - Country:US
Practice Address - Phone:406-587-3788
Practice Address - Fax:406-587-3922
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTG92867Medicare UPIN