=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669623005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES C. IKEMBA, MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2008
-----------------------------------------------------
Last Update Date | 01/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12200 PARK CENTRAL DR STE 415
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75251-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-232-0218
-----------------------------------------------------
Fax | 214-660-0270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12200 PARK CENTRAL DR STE 415
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75251-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-232-0218
-----------------------------------------------------
Fax | 214-660-0270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JAMES CHUKWUMA IKEMBA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-232-0218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | L8084
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------