Provider Demographics
NPI:1295709897
Name:IKEJIANI, TOCHUKWU C (MD)
Entity type:Individual
Prefix:
First Name:TOCHUKWU
Middle Name:C
Last Name:IKEJIANI
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 330638
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-0638
Mailing Address - Country:US
Mailing Address - Phone:615-867-4753
Mailing Address - Fax:615-867-0177
Practice Address - Street 1:826 MEMORIAL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2738
Practice Address - Country:US
Practice Address - Phone:615-867-4753
Practice Address - Fax:615-867-0177
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34072207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00035887OtherRAILROAD MEDICARE PIN
TN3886850Medicaid
TN4070446OtherBLUE CROSS BLUESHIELD
TN4089201OtherTENNCARE SELECT
TN4070446OtherBLUE CROSS BLUESHIELD
TN4089201OtherTENNCARE SELECT