Healthcare Provider Details

I. General information

NPI: 1982933909
Provider Name (Legal Business Name): ASHISH ANIL TIKOTEKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE STE 215
CARMICHAEL CA
95608-0303
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-2449
  • Fax: 916-844-1565
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC183513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: