MEDICARE: DR. TAKEHISA IKEDA MD

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	208000000X	Pediatrics Physician	N0117	TX
2	208M00000X	Hospitalist Physician	N0117	TX
3	2080P0208X	Pediatric Infectious Diseases Physician	N0117	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326203266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAKEHISA IKEDA MD

Provider Business Mailing Address
First Line	:	PO BOX 3278
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77588-3278
Country	:	US
Telephone Number	:	713-464-9776
Fax Number	:	713-464-9771

Provider Business Practice Location Address
First Line	:	1140 BUSINESS CENTER DR STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-2742
Country	:	US
Telephone Number	:	713-464-9774
Fax Number	:	713-464-9771

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	10/11/2018

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Directions to “ DR. TAKEHISA IKEDA MD” Practice Location

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