Provider Demographics
NPI:1811902307
Name:EZIKE, ELIAS N (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:N
Last Name:EZIKE
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 1:87 INTERSTATE 10 N STE 221
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2562
Mailing Address - Country:US
Mailing Address - Phone:409-838-9944
Mailing Address - Fax:409-838-9086
Practice Address - Street 1:87 INTERSTATE 10 N STE 221
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2562
Practice Address - Country:US
Practice Address - Phone:409-838-9944
Practice Address - Fax:409-838-9086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052430208000000X
TXM47742080P0208X, 208000000X
MI4301076996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193069506Medicaid
GA990624171AMedicaid