Provider Demographics
NPI:1912233115
Name:ELIAS EZIKE, MD, P.A
Entity Type:Organization
Organization Name:ELIAS EZIKE, MD, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:EZIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-212-5390
Mailing Address - Street 1:PO BOX 5038
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-5038
Mailing Address - Country:US
Mailing Address - Phone:409-212-5390
Mailing Address - Fax:409-212-7431
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:SUITE 100B
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-212-5390
Practice Address - Fax:409-212-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM47742080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty