Provider Demographics
NPI:1235122359
Name:RYKEN, TIMOTHY C (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:RYKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-1654
Mailing Address - Country:US
Mailing Address - Phone:319-331-6603
Mailing Address - Fax:
Practice Address - Street 1:1215 PLEASANT ST STE 608
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1418
Practice Address - Country:US
Practice Address - Phone:515-241-5760
Practice Address - Fax:515-241-8161
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-28456207T00000X
NH18138207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1030057Medicaid
NH3109341Medicaid
G31630Medicare UPIN
IA45506OtherWELLMARK BCBS
IA0176248Medicaid