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1568859635 NPI number — JOSEPH C IKEKWERE M.D, MPH

NPI Number: 1568859635
Health Care Provider/Practitioner: JOSEPH C IKEKWERE M.D, MPH

Information about “1568859635” NPI (JOSEPH C IKEKWERE M.D, MPH) exists in 1568859635 in HTML format HTML  |  1568859635 in plain Text format TXT  |  1568859635 in PDF (Portable Document Format) PDF  |  1568859635 in an XML format XML  formats.

NPI Number : 1568859635 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568859635",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "IKEKWERE",
    "FirstName": "JOSEPH",
    "MiddleName": "C",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D,  MPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 4088",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CEDAR PARK",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78630-4088",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-621-4547",
    "MailingAddressFaxNumber": "312-957-2834",
    "FirstLinePracticeLocationAddress": "3101 S AUSTIN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GEORGETOWN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78626-7541",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-621-4547",
    "PracticeLocationAddressFaxNumber": "312-729-6582",
    "EnumerationDate": "04/16/2015",
    "LastUpdateDate": "02/12/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0802X",
          "TaxonomyName": "Addiction Psychiatry Physician",
          "LicenseNumber": "036.152582",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "4301114201",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "T1395",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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