Provider Demographics
NPI:1386638690
Name:LYKKE, TIMOTHY W (DPM, CWS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:LYKKE
Suffix:
Gender:M
Credentials:DPM, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17070 RED OAK DR
Mailing Address - Street 2:STE. 209
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2619
Mailing Address - Country:US
Mailing Address - Phone:281-537-1999
Mailing Address - Fax:281-537-1978
Practice Address - Street 1:17070 RED OAK DR
Practice Address - Street 2:STE. 209
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2619
Practice Address - Country:US
Practice Address - Phone:281-537-1999
Practice Address - Fax:281-537-1978
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0645213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018733802Medicaid
TXT14522Medicare UPIN
TX00041TMedicare PIN