Provider Demographics
NPI:1124385760
Name:IKEMD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:IKEMD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:AR
Authorized Official - Last Name:IKEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-717-3050
Mailing Address - Street 1:2547 PALMYRA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6427
Mailing Address - Country:US
Mailing Address - Phone:504-754-2388
Mailing Address - Fax:504-754-7669
Practice Address - Street 1:2547 PALMYRA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6427
Practice Address - Country:US
Practice Address - Phone:504-754-2388
Practice Address - Fax:504-754-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205087251S00000X, 261QC1500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care