Provider Demographics
NPI:1184668956
Name:TIKHTMAN, ALEXANDER JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JACOB
Last Name:TIKHTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:1775 ALYSHEBA WAY
Practice Address - Street 2:SUITE 160
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9023
Practice Address - Country:US
Practice Address - Phone:859-260-5057
Practice Address - Fax:859-260-5058
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64277593Medicaid
KYF78932Medicare UPIN
KY64277593Medicaid