MEDICARE: TIM LEKIC M.D., PH.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	2084N0400X	Neurology Physician	01076241A	IN
2	2084N0400X	Neurology Physician	MD458093	PA

General Provider Information

NPI Number	:	1578855151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIM LEKIC M.D., PH.D.

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:	717-851-6969

Provider Business Practice Location Address
First Line	:	46100 WASHINGTON ST
Second Line	:
City	:	LA QUINTA
State	:	CA
Zip	:	92253-2042
Country	:	US
Telephone Number	:	760-340-0528
Fax Number	:	760-674-1590

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

Provider Enumeration Date	:	05/13/2011
Last Update Date	:	10/29/2024

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