Healthcare Provider Details

I. General information

NPI: 1780017988
Provider Name (Legal Business Name): ISAAC IKWU UCHECHUKWU IKWU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

12600 GLADYS RETREAT CIR
BOWIE MD
20720-3338
US

V. Phone/Fax

Practice location:
  • Phone: 240-965-3712
  • Fax:
Mailing address:
  • Phone: 203-543-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.063566
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0099611
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0099611
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: