Provider Demographics
NPI:1568407443
Name:IKE, TAMI LEE (AUD)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:LEE
Last Name:IKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8123
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:532 N ELAM AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1156
Practice Address - Country:US
Practice Address - Phone:336-852-4095
Practice Address - Fax:336-852-4097
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1691237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45269OtherBCBS NC INDIVIDUAL PROVID
NC2520238Medicare ID - Type UnspecifiedIND MEDICARE NUMBER