Provider Demographics
NPI:1386843779
Name:COMPREHENSIVE MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL ASSOCIATES, PLLC
Other - Org Name:SHERRY ZILBERT IKALOWYCH, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:IKALOWYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD MS
Authorized Official - Phone:910-454-4032
Mailing Address - Street 1:5130 SOUTHPORT SUPPLY RD SE
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-9261
Mailing Address - Country:US
Mailing Address - Phone:910-454-4032
Mailing Address - Fax:910-454-4033
Practice Address - Street 1:5130 SOUTHPORT SUPPLY RD SE
Practice Address - Street 2:SUITE 101 A
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-9261
Practice Address - Country:US
Practice Address - Phone:910-454-4032
Practice Address - Fax:910-454-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902156Medicaid
9406199OtherPHCS
NC140K2OtherBCBS OF NC
NC8089924OtherCIGNA
NC232191Medicare PIN
NC8089924OtherCIGNA