Provider Demographics
NPI:1558361014
Name:TIKKER, ROELOF (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROELOF
Middle Name:
Last Name:TIKKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 SILVERADO SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-1556
Mailing Address - Country:US
Mailing Address - Phone:707-237-2673
Mailing Address - Fax:916-914-2157
Practice Address - Street 1:6 WOODLAND RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:707-237-2673
Practice Address - Fax:916-914-2157
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE882213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000E8820Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAT11823Medicare UPIN