Healthcare Provider Details

I. General information

NPI: 1033159678
Provider Name (Legal Business Name): DAVID G IKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 BOILING SPRINGS RD
SPARTANBURG SC
29303-2248
US

IV. Provider business mailing address

1083 BOILING SPRINGS RD
SPARTANBURG SC
29303-2248
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-8647
  • Fax: 864-542-2227
Mailing address:
  • Phone: 864-583-8647
  • Fax: 864-542-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14849
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number14849
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number14849
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: