=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649356197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN OKECHUCKWU IKE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 03/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7500 BEECHNUT ST SUITE # 152
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-777-2790
-----------------------------------------------------
Fax | 713-777-2405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7500 BEECHNUT ST SUITE # 152
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-777-2790
-----------------------------------------------------
Fax | 713-777-2405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | J7524
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------