Healthcare Provider Details

I. General information

NPI: 1619276102
Provider Name (Legal Business Name): THOMAS LEWIS TZIKAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 SE 5TH AVE
DELRAY BEACH FL
33483-5213
US

IV. Provider business mailing address

526 SE 5TH AVE
DELRAY BEACH FL
33483-5213
US

V. Phone/Fax

Practice location:
  • Phone: 561-330-9500
  • Fax: 561-330-8629
Mailing address:
  • Phone: 561-330-9500
  • Fax: 561-330-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME70709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: