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General NPI Number Information
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NPI Number | 1568859635
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Entity Type | Individual
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Provider Name | JOSEPH C IKEKWERE M.D, MPH
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Gender | Male
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 02/12/2023
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Provider Practice Location Address
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Address Line | 3101 S AUSTIN AVE
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City | GEORGETOWN
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State | TX
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Zip | 78626-7541
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Country | US
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Telephone | 512-621-4547
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Fax | 312-729-6582
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Provider Business Mailing Address
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Address Line | PO BOX 4088
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City | CEDAR PARK
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State | TX
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Zip | 78630-4088
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Country | US
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Telephone | 512-621-4547
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Fax | 312-957-2834
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 036.152582
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301114201
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | T1395
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License Number State | TX
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