Basic Information
| Provider Information | |||||||||
| NPI: | 1568859635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IKEKWERE | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4088 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786304088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126214547 | ||||||||
| FaxNumber: | 3129572834 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 S AUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786267541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126214547 | ||||||||
| FaxNumber: | 3127296582 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2015 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | 036.152582 | IL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 2084P0800X | 4301114201 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | T1395 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.