Provider Demographics
NPI:1316029309
Name:DIKE-ODIMGBE, PATRICIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:E
Last Name:DIKE-ODIMGBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 HAMILTON ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-1200
Mailing Address - Country:US
Mailing Address - Phone:713-659-3565
Mailing Address - Fax:713-659-3629
Practice Address - Street 1:2424 HAMILTON ST
Practice Address - Street 2:SUITE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-1200
Practice Address - Country:US
Practice Address - Phone:713-659-3565
Practice Address - Fax:713-659-3629
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6866208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120368902Medicaid
TX120368902Medicaid