MEDICARE: TSAMBIKA MICHAEL BAKIRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	24871	TX

General Provider Information

NPI Number	:	1083874952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TSAMBIKA MICHAEL BAKIRIS

Provider Business Mailing Address
First Line	:	PO BOX 202333
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78720-2333
Country	:	US
Telephone Number	:	210-445-4880
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 HARVEST HILL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1684
Country	:	US
Telephone Number	:	210-445-4880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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