Provider Demographics
NPI:1669623005
Name:JAMES C. IKEMBA, MD PA
Entity type:Organization
Organization Name:JAMES C. IKEMBA, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHUKWUMA
Authorized Official - Last Name:IKEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-232-0218
Mailing Address - Street 1:12200 PARK CENTRAL DR
Mailing Address - Street 2:STE 415
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2100
Mailing Address - Country:US
Mailing Address - Phone:972-232-0218
Mailing Address - Fax:214-660-0270
Practice Address - Street 1:12200 PARK CENTRAL DR
Practice Address - Street 2:STE 415
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2100
Practice Address - Country:US
Practice Address - Phone:972-232-0218
Practice Address - Fax:214-660-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0070Medicare PIN