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NPI Code Detail

MEDICARE: DR. STEPHANIE A IKEME D.O.

MEDICARE: DR. STEPHANIE A IKEME D.O.
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
1207Q00000XFamily Medicine Physician2016015924MO
2207Q00000XFamily Medicine PhysicianOS015504PA
3207Q00000XFamily Medicine Physician05-41757KS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1KA5102009OTHERKSMEDICARE
2MA8204011OTHERMOMEDICARE

General Provider Information

NPI Number : 1790921914
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE A IKEME D.O.
Provider Business Mailing Address
First Line : PO BOX 616788
Second Line :
City : ORLANDO
State : FL
Zip : 32861-6788
Country : US
Telephone Number : 407-447-7120
Fax Number : 407-770-0661
Provider Business Practice Location Address
First Line : 7527 STATE AVE
Second Line :
City : KANSAS CITY
State : KS
Zip : 66112-2815
Country : US
Telephone Number : 913-335-6986
Fax Number : 855-446-7151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2008
Last Update Date : 11/29/2021

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