Provider Demographics
NPI:1679680391
Name:IKEKPEAZU, NKEMAKONAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:NKEMAKONAM
Middle Name:H
Last Name:IKEKPEAZU
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 1:764 CAMPBELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3786
Mailing Address - Country:US
Mailing Address - Phone:203-937-8778
Mailing Address - Fax:203-937-5712
Practice Address - Street 1:764 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3786
Practice Address - Country:US
Practice Address - Phone:203-937-8778
Practice Address - Fax:203-937-5712
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037057208600000X
TXQ5821174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001370577Medicaid
CT001370577Medicaid
020001425Medicare ID - Type Unspecified