1740377290 NPI number — DR. JAMEELA BAI TIKU M.D.

Table of content: DR. JAMEELA BAI TIKU M.D. (NPI 1740377290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740377290 NPI number — DR. JAMEELA BAI TIKU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIKU
Provider First Name:
JAMEELA
Provider Middle Name:
BAI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740377290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RATON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87740-0968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-445-5548
Provider Business Mailing Address Fax Number:
575-445-5560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RATON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87740-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-445-5548
Provider Business Practice Location Address Fax Number:
575-445-5560
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  76-108 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 27847 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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