Physician Compare National (NPI:1679680391)

HEALTHCARE PROVIDER: NKEMAKONAM H IKEKPEAZU MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1679680391
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1759555287
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111119000100
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	IKEKPEAZU
	Individual professional last name
Provider First Name	NKEMAKONAM
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	764 CAMPBELL AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	WEST HAVEN
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	065163786
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2039378778
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	070022
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	YALE-NEW HAVEN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y