Provider Demographics
NPI:1225202146
Name:CHRISTOPHER D. TYKOCKI D.O. P.C.
Entity Type:Organization
Organization Name:CHRISTOPHER D. TYKOCKI D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:TYKOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-694-2720
Mailing Address - Street 1:8245 HOLLY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2443
Mailing Address - Country:US
Mailing Address - Phone:810-694-2720
Mailing Address - Fax:810-953-4473
Practice Address - Street 1:8245 HOLLY RD STE 103
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2443
Practice Address - Country:US
Practice Address - Phone:810-694-2720
Practice Address - Fax:810-953-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICT012113207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4228726Medicaid
MI0980879OtherHEALTH PLUS OF MICHIGAN
MI1652501375OtherBCBSM
MI1652501375OtherBCN
MI5404569OtherAETNA
MI4228726Medicaid
MI1652501375OtherBCN