Provider Demographics
NPI:1518022698
Name:BLANKENBERG, TIKOES A (MD)
Entity Type:Individual
Prefix:DR
First Name:TIKOES
Middle Name:A
Last Name:BLANKENBERG
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 1:2036 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1801
Mailing Address - Country:US
Mailing Address - Phone:530-255-1000
Mailing Address - Fax:530-247-8259
Practice Address - Street 1:2036 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1801
Practice Address - Country:US
Practice Address - Phone:530-255-1000
Practice Address - Fax:530-247-8259
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56842207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58543ZMedicaid
CAF18637Medicare UPIN
CAZZZ58543ZMedicaid