Individual provider Active NPI

Roma Lubow Ilkiw, MD

  • Pediatric Cardiology Physician
  • Houston, TX
National Provider Identifier
1740794130
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
H8692 Issued in TX
Practice address
6624 Fannin St Ste 1450
Houston, TX 77030-2385
Phone
(713) 799-9916
Fax
(713) 799-9917
NPI assigned
Nov 22, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X H8692 TX Primary

Addresses

Primary practice location

6624 Fannin St Ste 1450
Houston, TX 77030-2385

Mailing address

6624 Fannin St Ste 1450
Houston, TX 77030-2385
Phone (713) 799-9916

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
H8692TXMDPediatric Cardiology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1740794130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6624 FANNIN ST STE 1450",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302385",
            "telephone_number": "713-799-9916",
            "fax_number": "713-799-9917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6624 FANNIN ST STE 1450",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302385",
            "telephone_number": "713-799-9916",
            "fax_number": "713-799-9917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILKIW",
        "first_name": "ROMA",
        "middle_name": "LUBOW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-22",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "TX",
            "license": "H8692",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.