Provider Demographics
NPI:1740794130
Name:ILKIW, ROMA LUBOW (MD)
Entity Type:Individual
Prefix:
First Name:ROMA
Middle Name:LUBOW
Last Name:ILKIW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6624 FANNIN ST STE 1450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2385
Mailing Address - Country:US
Mailing Address - Phone:713-799-9916
Mailing Address - Fax:713-799-9917
Practice Address - Street 1:6624 FANNIN ST STE 1450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2385
Practice Address - Country:US
Practice Address - Phone:713-799-9916
Practice Address - Fax:713-799-9917
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH86922080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology