MEDICARE: DR. JOHN K IJEM M.D.

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	207RC0000X	Cardiovascular Disease Physician	22234	SC

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	:	1457353138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN K IJEM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-527-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9653 OCEAN HWY
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-7425
Country	:	US
Telephone Number	:	843-235-3131
Fax Number	:	843-237-9646

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/30/2026

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