Provider Demographics
NPI:1811296494
Name:ANIKWUE, RENE CHIKE (MD)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:CHIKE
Last Name:ANIKWUE
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 1:5109 MONROE RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7879
Mailing Address - Country:US
Mailing Address - Phone:704-364-4216
Mailing Address - Fax:704-366-6391
Practice Address - Street 1:5109 MONROE RD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7879
Practice Address - Country:US
Practice Address - Phone:704-364-4216
Practice Address - Fax:704-366-6391
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-02373208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811296494Medicaid