Provider Demographics
NPI:1427288174
Name:IDEM, IFIOK AKPAN (MD)
Entity type:Individual
Prefix:
First Name:IFIOK
Middle Name:AKPAN
Last Name:IDEM
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 1:12101 RAYNER PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6059
Mailing Address - Country:US
Mailing Address - Phone:216-682-5519
Mailing Address - Fax:888-730-1925
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2431
Practice Address - Country:US
Practice Address - Phone:512-730-3056
Practice Address - Fax:888-730-1925
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01286208M00000X
VA0101249474207R00000X
OH35.097385207R00000X
IN01073264A207R00000X
KY44424207R00000X
IDM14550207R00000X
TXP9879208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine