Provider Demographics
NPI:1801078506
Name:IKURU, ESTHER (MD)
Entity type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:
Last Name:IKURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2437
Mailing Address - Country:US
Mailing Address - Phone:704-535-0400
Mailing Address - Fax:704-535-3443
Practice Address - Street 1:1805 MILTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-2437
Practice Address - Country:US
Practice Address - Phone:704-535-0400
Practice Address - Fax:704-535-3443
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200701210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC298047Medicaid
SCAA79169068Medicare UPIN
SCAA79165019Medicare UPIN