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General NPI Number Information
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NPI Number | 1942674346
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Entity Type | Organization
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Legal Business Name | PROCENTURE HEALTHCARE SERVICES PLLC
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 3033 CHIMNEY ROCK RD STE 519
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City | HOUSTON
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State | TX
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Zip | 77056-6260
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Country | US
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Telephone | 281-915-1630
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 CHIMNEY ROCK RD STE 519
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City | HOUSTON
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State | TX
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Zip | 77056-6260
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Country | US
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Telephone | 281-915-1630
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IKE C ILOCHONWU
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Credential | MD
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Telephone | 281-915-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P3356
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License Number State | TX
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