Provider Demographics
NPI:1689315640
Name:TELCHIK, COLLIN MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:MITCHELL
Last Name:TELCHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:COLLIN
Other - Middle Name:MITCHELL
Other - Last Name:TELCHIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2401 S 31ST ST # MSAG407Q
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508-0001
Mailing Address - Country:US
Mailing Address - Phone:254-724-8797
Mailing Address - Fax:254-724-4079
Practice Address - Street 1:2401 S 31ST ST # MSAG407Q
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-8797
Practice Address - Fax:254-724-4079
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program