MEDICARE: MR. GUY IKE JOEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1043596638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GUY IKE JOEL

Provider Business Mailing Address
First Line	:	13110 KUYKENDAHL RD
Second Line	:	# 2306
City	:	HOUSTON
State	:	TX
Zip	:	77090-6715
Country	:	US
Telephone Number	:	832-921-9778
Fax Number	:

Provider Business Practice Location Address
First Line	:	13110 KUYKENDAHL RD
Second Line	:	# 2306
City	:	HOUSTON
State	:	TX
Zip	:	77090-6715
Country	:	US
Telephone Number	:	832-921-9778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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Directions to “ MR. GUY IKE JOEL ” Practice Location

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