Provider Demographics
NPI:1831415637
Name:EJIKE, CHINEDU OLISAEMEKA (MD)
Entity type:Individual
Prefix:
First Name:CHINEDU
Middle Name:OLISAEMEKA
Last Name:EJIKE
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 1:1921 RIVER VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3450
Mailing Address - Country:US
Mailing Address - Phone:301-675-7160
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DRIVE
Practice Address - Street 2:B1 FLOOR TAUBMAN CENTER RECP MOS RM 126
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5317
Practice Address - Country:US
Practice Address - Phone:734-232-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108174207R00000X
MDD85059207R00000X
OH35.120851207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.120851OtherOHIO LICENSE
MDD0085059OtherMARYLAND MD LICENSE