Provider Demographics
NPI:1043596638
Name:JOEL, GUY IKE
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:IKE
Last Name:JOEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GAIUS
Other - Middle Name:ONWEZI
Other - Last Name:ONUEGBU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13110 KUYKENDAHL RD
Mailing Address - Street 2:# 2306
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-6715
Mailing Address - Country:US
Mailing Address - Phone:832-921-9778
Mailing Address - Fax:
Practice Address - Street 1:13110 KUYKENDAHL RD
Practice Address - Street 2:# 2306
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-6715
Practice Address - Country:US
Practice Address - Phone:832-921-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker