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General NPI Number Information
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NPI Number | 1508377599
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Entity Type | Organization
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Legal Business Name | PROCENTURE LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 2311 CANAL ST STE 214
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City | HOUSTON
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State | TX
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Zip | 77003-1566
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Country | US
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Telephone | 713-459-2566
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 ALMEDA RD UNIT 11701
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City | HOUSTON
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State | TX
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Zip | 77004-7677
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Country | US
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Telephone | 713-459-2566
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IKE C ILOCHONWU
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Credential | MD
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Telephone | 713-459-2566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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