MEDICARE: RED OAK PODIATRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0645	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083729156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED OAK PODIATRY, PC

Provider Business Mailing Address
First Line	:	17070 RED OAK DR STE 209
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2615
Country	:	US
Telephone Number	:	281-537-1999
Fax Number	:	281-537-1978

Provider Business Practice Location Address
First Line	:	17070 RED OAK DR
Second Line	:	STE 209
City	:	HOUSTON
State	:	TX
Zip	:	77090-2615
Country	:	US
Telephone Number	:	281-537-1999
Fax Number	:	281-537-1978

Authorized Official
Title or Position	:	DOCTOR OF PODIATRIC MEDICINE
Name	:	DR. TIMOTHY W. LYKKE
Credential	:	D.P.M.
Telephone Number	:	281-537-1999

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	04/29/2008

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