Tidik, Stephen J

Tidik, Stephen J is an individual health care provider with primary practice located at 77 Casa St Suite 103, San Luis Obispo CA 93405-5803. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Tidik, Stephen J can be contacted via phone (805) 544-8993.

Contact Information

Primary practice address
77 Casa St Suite 103 San Luis Obispo CA 93405-5803
Phone: (805) 544-8993
Fax: (805) 544-0120
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X G57086 California
Allopathic & Osteopathic Physicians / Surgery 208600000X G57086 California

Profile Details

NPI number 1053306803
LBN Legal business name Tidik, Stephen J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2005
Last updated Jun 17th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053306803 NPPES
California Other G57086 MEDICAL LICENSE
California MEDICAID 00G570860 MEDICAL LICENSE

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