Healthcare Provider Details

I. General information

NPI: 1457358517
Provider Name (Legal Business Name): MELLICK T. SYKES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MEDICAL DR STE 120
SAN ANTONIO TX
78229-3342
US

IV. Provider business mailing address

5047 SHERRI ANN RD
SAN ANTONIO TX
78229-3353
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-7414
  • Fax: 210-616-0509
Mailing address:
  • Phone: 210-237-4400
  • Fax: 210-828-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMDE6643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: