Provider Demographics
NPI:1508360629
Name:KIKAH ATEM, NGUM (MD)
Entity Type:Individual
Prefix:DR
First Name:NGUM
Middle Name:
Last Name:KIKAH ATEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NGUM
Other - Middle Name:
Other - Last Name:KIKAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7301 SW LEE BLVD APT 228
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-0414
Mailing Address - Country:US
Mailing Address - Phone:214-394-8161
Mailing Address - Fax:
Practice Address - Street 1:7301 SW LEE BLVD APT 228
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-0414
Practice Address - Country:US
Practice Address - Phone:214-394-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38338207R00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program