Healthcare Provider Details

I. General information

NPI: 1831415637
Provider Name (Legal Business Name): CHINEDU OLISAEMEKA EJIKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DRIVE B1 FLOOR TAUBMAN CENTER RECP MOS RM 126
ANN ARBOR MI
48109-5317
US

IV. Provider business mailing address

1921 RIVER VISTA DR
ESSEX MD
21221-3450
US

V. Phone/Fax

Practice location:
  • Phone: 734-232-2867
  • Fax:
Mailing address:
  • Phone: 301-675-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01100202A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.120851
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301108174
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01100202A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD85059
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.120851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: