Provider Demographics
NPI:1649356197
Name:IKE, JOHN OKECHUCKWU (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:OKECHUCKWU
Last Name:IKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7500 BEECHNUT ST
Mailing Address - Street 2:SUITE # 152
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4335
Mailing Address - Country:US
Mailing Address - Phone:713-777-2790
Mailing Address - Fax:713-777-2405
Practice Address - Street 1:7500 BEECHNUT ST
Practice Address - Street 2:SUITE # 152
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4335
Practice Address - Country:US
Practice Address - Phone:713-777-2790
Practice Address - Fax:713-777-2405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7524207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139822420Medicaid
TX139822420Medicaid
TXF74012Medicare UPIN