Provider Demographics
NPI:1568859635
Name:IKEKWERE, JOSEPH C (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:IKEKWERE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4088
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78630-4088
Mailing Address - Country:US
Mailing Address - Phone:512-621-4547
Mailing Address - Fax:312-957-2834
Practice Address - Street 1:3101 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7541
Practice Address - Country:US
Practice Address - Phone:512-621-4547
Practice Address - Fax:312-729-6582
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1525822084P0802X
MI43011142012084P0800X
TXT13952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry