Provider Demographics
NPI:1477565208
Name:TSCHICKARDT, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:TSCHICKARDT
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 1:7101 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4947
Mailing Address - Country:US
Mailing Address - Phone:361-854-1910
Mailing Address - Fax:361-884-1555
Practice Address - Street 1:7101 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4947
Practice Address - Country:US
Practice Address - Phone:361-854-1910
Practice Address - Fax:361-884-1555
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL 6686208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1589350Medicaid
TX8F2467Medicare ID - Type Unspecified
TX1589350Medicaid