Provider Demographics
NPI:1629051834
Name:PELEG, IKA IZCHAK (MD)
Entity Type:Individual
Prefix:
First Name:IKA
Middle Name:IZCHAK
Last Name:PELEG
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:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-619-4101
Mailing Address - Fax:918-619-4110
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:3RD FLOOR, STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4101
Practice Address - Fax:918-619-4110
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29973207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine