MEDICARE: S. IKPE MD, LLC

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1487475158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. IKPE MD, LLC

Provider Business Mailing Address
First Line	:	8003 LINFIELD WAY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-5060
Country	:	US
Telephone Number	:	816-588-7916
Fax Number	:

Provider Business Practice Location Address
First Line	:	8003 LINFIELD WAY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-5060
Country	:	US
Telephone Number	:	816-588-7916
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PROVIDER
Name	:	DR. STEPHENSON AMANZE IKPE JR.
Credential	:	MD
Telephone Number	:	816-588-7916

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	10/24/2024

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