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General NPI Number Information
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NPI Number | 1912233115
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Entity Type | Organization
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Legal Business Name | ELIAS EZIKE, MD, P.A
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 87 INTERSTATE 10 N. SUITE 221
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City | BEAUMONT
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State | TX
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Zip | 77707-2562
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Country | US
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Telephone | 409-838-9944
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Fax | 409-838-9086
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Provider Business Mailing Address
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Address Line | 87 INTERSTATE 10 N. SUITE 221
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City | BEAUMONT
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State | TX
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Zip | 77707-2562
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Country | US
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Telephone | 409-838-9944
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Fax | 409-838-9086
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIAS NNAMDI EZIKE
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Credential | M.D
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Telephone | 409-838-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | M4774
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License Number State | TX
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