Healthcare Provider Details

I. General information

NPI: 1811952153
Provider Name (Legal Business Name): JAMES IGNATIUS TIKELLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON ROAD MEDICAL ARTS PAVILION 2, SUITE 3301
NEWARK DE
19713-2067
US

IV. Provider business mailing address

200 HYGEIA DR SUITE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 302-623-4375
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC10002901
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: