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NPI Code Detail

MEDICARE: DR. CECILY ELLEN LYKES D.O.

MEDICARE: DR. CECILY ELLEN LYKES D.O.
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
1208600000XSurgery Physician39353SC

General Provider Information

NPI Number : 1386917763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CECILY ELLEN LYKES D.O.
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 1333 TAYLOR ST STE 5F
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-2951
Country : US
Telephone Number : 803-748-9966
Fax Number : 803-748-7174
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2012
Last Update Date : 08/02/2023

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