MEDICARE: DR. KAFUI VIDA TSIKATA M.D.

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	207Q00000X	Family Medicine Physician	0101240312	VA

General Provider Information

NPI Number	:	1548333453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAFUI VIDA TSIKATA M.D.

Provider Business Mailing Address
First Line	:	4801 VALLEY OVERLOOK DR
Second Line	:	APT. 201
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-8650
Country	:	US
Telephone Number	:	302-981-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 VALLEY OVERLOOK DR
Second Line	:	APT. 201
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-8650
Country	:	US
Telephone Number	:	302-981-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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