Provider Demographics
NPI:1326479460
Name:IHEME, CHIAMAKA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHIAMAKA
Middle Name:
Last Name:IHEME
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 1:120 CYPRESS EDGE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8453
Mailing Address - Country:US
Mailing Address - Phone:386-586-4462
Mailing Address - Fax:386-586-4463
Practice Address - Street 1:120 CYPRESS EDGE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8453
Practice Address - Country:US
Practice Address - Phone:386-586-4462
Practice Address - Fax:386-586-4463
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN 17495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME121226OtherFL MEDICAL LICENSE
FLME121226OtherFL MEDICAL LICENSE