Provider Demographics
NPI:1235162488
Name:DIKE, CHIDIADI ALOZIE (MD)
Entity Type:Individual
Prefix:
First Name:CHIDIADI
Middle Name:ALOZIE
Last Name:DIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 DEE ST
Mailing Address - Street 2:#118
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2628
Mailing Address - Country:US
Mailing Address - Phone:318-219-0426
Mailing Address - Fax:318-636-1718
Practice Address - Street 1:5930 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-3816
Practice Address - Country:US
Practice Address - Phone:318-636-1717
Practice Address - Fax:318-636-1718
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13098R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1437905Medicaid
G04094Medicare UPIN
LA4A129DD34Medicare PIN