Provider Demographics
NPI:1215191697
Name:IKP FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:IKP FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-587-1700
Mailing Address - Street 1:21309 FOSTER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4209
Mailing Address - Country:US
Mailing Address - Phone:281-587-1700
Mailing Address - Fax:281-586-3808
Practice Address - Street 1:11026 HIGHWAY 242
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-4348
Practice Address - Country:US
Practice Address - Phone:281-587-1700
Practice Address - Fax:281-907-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00531ZMedicare PIN