MEDICARE: MARCOS HIROSHI IKEDA PA

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	207VX0000X	Obstetrics Physician	N6375	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	:	1811385081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCOS HIROSHI IKEDA PA

Provider Business Mailing Address
First Line	:	415 W LITTLE YORK RD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77076-1349
Country	:	US
Telephone Number	:	713-692-0600
Fax Number	:	713-699-9352

Provider Business Practice Location Address
First Line	:	415 W LITTLE YORK RD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77076-1349
Country	:	US
Telephone Number	:	713-692-0600
Fax Number	:	713-699-9352

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCOS HIROSHI IKEDA
Credential	:	M.D.
Telephone Number	:	713-692-0600

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	03/31/2017

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