Healthcare Provider Details

I. General information

NPI: 1962817502
Provider Name (Legal Business Name): MR. JAMES TICHY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 NE 1ST AVE
DELRAY BEACH FL
33444-3715
US

IV. Provider business mailing address

1730 S FEDERAL HWY #289
DELRAY BEACH FL
33483-3309
US

V. Phone/Fax

Practice location:
  • Phone: 561-808-7581
  • Fax: 561-808-7607
Mailing address:
  • Phone: 561-808-7581
  • Fax: 561-808-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1699854562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: