Provider Demographics
NPI:1003555350
Name:IKE, CHUKWUKA ANNEDOZIE
Entity Type:Individual
Prefix:
First Name:CHUKWUKA
Middle Name:ANNEDOZIE
Last Name:IKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 CRESTMONT PLACE LOOP
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1450
Mailing Address - Country:US
Mailing Address - Phone:832-633-5699
Mailing Address - Fax:
Practice Address - Street 1:919 CRESTMONT PLACE LOOP
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-1450
Practice Address - Country:US
Practice Address - Phone:832-633-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver