Provider Demographics
NPI:1457358517
Name:SYKES, MELLICK T (MD)
Entity type:Individual
Prefix:
First Name:MELLICK
Middle Name:T
Last Name:SYKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5047 SHERRI ANN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3353
Mailing Address - Country:US
Mailing Address - Phone:210-237-4400
Mailing Address - Fax:210-828-0590
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:STE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-614-7414
Practice Address - Fax:210-616-0509
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXMDE66432086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122736505Medicaid
TXSY085691NMedicare ID - Type Unspecified
TXC22437Medicare UPIN