Provider Demographics
NPI:1124055579
Name:IKEMBA, JAMES CHUKWUMA (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHUKWUMA
Last Name:IKEMBA
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 1:12200 PARK CENTRAL DR
Mailing Address - Street 2:STE 415
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2100
Mailing Address - Country:US
Mailing Address - Phone:972-232-0218
Mailing Address - Fax:214-660-0270
Practice Address - Street 1:12200 PARK CENTRAL DR
Practice Address - Street 2:STE 415
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2100
Practice Address - Country:US
Practice Address - Phone:972-232-0218
Practice Address - Fax:214-660-0270
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7946OtherMEDICARE ID
TX165041801Medicaid
TX8F9490OtherMEDICARE ID
TX165041801Medicaid
TX8F7946OtherMEDICARE ID
TX8F7946Medicare PIN
TX8F9490Medicare PIN