MEDICARE: CHRISTOPHER D. TYKOCKI D.O. P.C.

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	207V00000X	Obstetrics & Gynecology Physician	CT012113	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0980879	OTHER	MI	HEALTH PLUS OF MICHIGAN
3	1652501375	OTHER	MI	BCBSM
4	1652501375	OTHER	MI	BCN
5	5404569	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1225202146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER D. TYKOCKI D.O. P.C.

Provider Business Mailing Address
First Line	:	8245 HOLLY RD STE 103
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2443
Country	:	US
Telephone Number	:	810-694-2720
Fax Number	:	810-953-4473

Provider Business Practice Location Address
First Line	:	8245 HOLLY RD STE 103
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2443
Country	:	US
Telephone Number	:	810-694-2720
Fax Number	:	810-953-4473

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER D TYKOCKI
Credential	:	D.O.
Telephone Number	:	810-694-2720

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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