DR. MICAH MARSHALL LIKNESS, M.D. - NPI NUMBER 1124269162

Summary

Provider Name: DR. MICAH MARSHALL LIKNESS, M.D.

NPI Number: 1124269162

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Organization: EAR NOSE AND THROAT ASSOCIATES PC

Address:
2525 FOX RUN PARKWAY
SUITE 101
YANKTON, SD
ZIP 57078

Phone Number: (605) 665-0062



Detailed Information

DR. Micah Marshall Likness, M.D. is a student in an organized health care education/training program in Yankton, SD with 6 years of experience. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1124269162 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF SOUTH DAKOTA SCHOOL OF MEDICINE
Graduation Year: 2008

The provider's business address is:

2525 FOX RUN PARKWAY
SUITE 101
YANKTON, SD
ZIP 57078-371
Phone: (605) 665-0062
Fax: (605) 665-0076

The enumeration date for this NPI number is 3/22/2009 and was last updated on 8/2/2013.

Map - Location of Practice

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NPI Provider Name / Taxonomy
1487972436 DR. SPENCER MENEES, M.D.
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1417273509 CHRISTY WIARDA
Student in an Organized Health Care Education/Training Program





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program No
2 207Y00000X Otolaryngology 8836 SD Yes

NPI Record

No. Field Name Field Value
1 NPI 1124269162
2 Entity Type Code 1
3 Provider Last Name Legal Name LIKNESS
4 Provider First Name MICAH
5 Provider Middle Name MARSHALL
6 Provider Name Prefix Text DR.
7 Provider Credential Text M.D.
8 Provider First Line Business Practice Location Address 2525 FOX RUN PARKWAY
9 Provider Second Line Business Practice Location Address SUITE 101
10 Provider Business Practice Location Address City Name YANKTON
11 Provider Business Practice Location Address State Name SD
12 Provider Business Practice Location Address Postal Code 570785371
13 Provider Business Practice Location Address Country Code If outside U S US
14 Provider Business Practice Location Address Telephone Number 6056650062
15 Provider Business Practice Location Address Fax Number 6056650076
16 Provider Enumeration Date 3/22/2009
17 Last Update Date 8/2/2013
18 Provider Gender Code M
19 Healthcare Provider Taxonomy Code 1 390200000X
20 Healthcare Provider Primary Taxonomy Switch 1 N
21 Healthcare Provider Taxonomy Code 2 207Y00000X
22 Provider License Number 2 8836
23 Provider License Number State Code 2 SD
24 Healthcare Provider Primary Taxonomy Switch 2 Y
25 Is Sole Proprietor N

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.