Individual
JIMMY O IBIKUNLE
Active
Individual
JIMMY O IBIKUNLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD073822L
PA
2084P0804X
Child & Adolescent Psychiatry Physician
MD073822L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001880921
—
PA
01
—
1448330
PA BLUE SHIELD
PA
01
—
2088368
CIGNA BEHAVIORAL HEALTH
PA
01
—
2103603
MAMSI
PA
01
—
284716000
MAGELLAN
PA
01
—
478844
VALUE OPTIONS
PA
01
—
50008800
CAPITAL BLUE CROSS
PA
01
—
618995
BC/BS OF MD CARE FIRST
PA
Enumeration date
06/15/2006
Last updated
05/10/2021
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