Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME74432 | FL |
NPI | 1023097441 |
---|---|
Provider Name | Dr. Michael Andrew Illovsky |
First Address | Jacksonville, FL 32255-1308 |
Second Address | Jacksonville, FL 32256-6954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 01/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004802800 | (05) | FL |
G64866 | (02) | FL |