Provider Demographics
NPI:1780615856
Name:BAKHSHI, TIKI (MD)
Entity type:Individual
Prefix:
First Name:TIKI
Middle Name:
Last Name:BAKHSHI
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 1:4445 KINGS BARN CT UNIT 403
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-8032
Mailing Address - Country:US
Mailing Address - Phone:910-364-4007
Mailing Address - Fax:
Practice Address - Street 1:4445 KINGS BARN CT UNIT 403
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-8032
Practice Address - Country:US
Practice Address - Phone:910-364-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1486207V00000X, 207VM0101X
FLME130347207VM0101X
IN01055791A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176438301Medicaid
TX8H3607OtherBCBS
FL019245300Medicaid
FLIU378ZMedicare PIN
FL019245300Medicaid