Healthcare Provider Details

I. General information

NPI: 1659015345
Provider Name (Legal Business Name): MICHELLE MARIKO IKOMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 FREEPORT ROAD, UPMC ST. MARGARET DEPT OF MEDICAL ED
PITTSBURGH PA
15215
US

IV. Provider business mailing address

815 FREEPORT RD
PITTSBURGH PA
15215-3301
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-4227
  • Fax:
Mailing address:
  • Phone: 412-784-4227
  • Fax: 412-784-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD489962
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: