Provider Demographics
NPI:1780762484
Name:IKEMIRE, MONTE E (MD)
Entity type:Individual
Prefix:
First Name:MONTE
Middle Name:E
Last Name:IKEMIRE
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 1:995 SAN RAMON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5233
Mailing Address - Country:US
Mailing Address - Phone:916-487-2434
Mailing Address - Fax:916-487-9636
Practice Address - Street 1:995 SAN RAMON WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5233
Practice Address - Country:US
Practice Address - Phone:916-487-2434
Practice Address - Fax:916-487-9636
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G273790Medicaid
00G273790Medicare ID - Type Unspecified
CA00G273790Medicaid