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General NPI Number Information
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NPI Number | 1679617153
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Entity Type | Organization
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Legal Business Name | DOCTORS TIKU PC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 130 S 3RD ST
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City | RATON
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State | NM
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Zip | 87740-3910
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Country | US
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Telephone | 575-445-5548
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Fax | 575-445-5560
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Provider Business Mailing Address
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Address Line | PO BOX 968
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City | RATON
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State | NM
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Zip | 87740-0968
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Country | US
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Telephone | 575-445-5548
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Fax | 575-445-5560
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Authorized Official
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Title or Position | PRESIDENT
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Name | OMKAR N TIKU
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Credential | M.D.
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Telephone | 575-445-5548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 76-108
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 76-109
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License Number State | NM
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