Provider Demographics
NPI:1316662240
Name:TIKU, SIMON A
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:A
Last Name:TIKU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14735 BLACKBURN RD
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1397
Mailing Address - Country:US
Mailing Address - Phone:678-200-8114
Mailing Address - Fax:
Practice Address - Street 1:14735 BLACKBURN RD
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1397
Practice Address - Country:US
Practice Address - Phone:678-200-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator