Provider Demographics
NPI:1558505438
Name:ILOCHONWU, IKECHUKWU CHRIS (MD)
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:CHRIS
Last Name:ILOCHONWU
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 1:2014 WENTWORTH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6084
Mailing Address - Country:US
Mailing Address - Phone:281-915-1630
Mailing Address - Fax:
Practice Address - Street 1:2311 CANAL ST
Practice Address - Street 2:STE 214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1566
Practice Address - Country:US
Practice Address - Phone:281-915-1630
Practice Address - Fax:281-476-7853
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314822302Medicaid
TX314822303Medicaid
TX314822304Medicaid
TX314822301Medicaid
TX271683YLP2Medicare PIN
TX314822304Medicaid
TX314822301Medicaid
TX314822303Medicaid
TX271683YKXVMedicare PIN