Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036130762 | IL |
N | 111NI0900X | Internist | 036130762 | IL |
N | 207R00000X | Internist | MT194826 | PA |
N | 111NI0900X | Internist | MT194826 | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD460573 | PA |
NPI | 1023329992 |
---|---|
Provider Name | Dr. Lilian Enyonam Ahiable |
First Address | South Pasadena, FL 33707-4567 |
Second Address | South Pasadena, FL 33707-4567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 27/08/2019 |