Active NPI
Kachikwu O Illoh, M.D.
- Neurology Physician
- Houston, TX
National Provider Identifier
1194779728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- M4190
- Practice address
- 6410 Fannin St
1014
Houston, TX 77030-3000 - Phone
- (832) 325-7080
- Fax
- (713) 512-2239
- NPI assigned
- May 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | M4190 | TX | Primary |
Addresses
Primary practice location
6410 Fannin St
1014
Houston, TX 77030-3000
Mailing address
PO Box 201088
Houston, TX 77216-1088
Phone (713) 500-3500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8R6142 | Other | TX | BCBSTX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40672 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Utmb Faculty Group Practice | Neurology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198022400000",
"number": "1194779728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 201088",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772161088",
"telephone_number": "713-500-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6410 FANNIN ST",
"address_2": "1014",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770303000",
"telephone_number": "832-325-7080",
"fax_number": "713-512-2239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLOH",
"first_name": "KACHIKWU",
"middle_name": "O",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-19",
"last_updated": "2007-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TX",
"license": "M4190",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX",
"identifier": "8R6142",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.