MEDICARE: MRS. ILEANA A VILA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME58476	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902891054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILEANA A VILA M.D.

Provider Business Mailing Address
First Line	:	7800 W OAKLAND PARK BLVD
Second Line	:	SUITE E-214
City	:	SUNRISE
State	:	FL
Zip	:	33351-6741
Country	:	US
Telephone Number	:	954-318-6590
Fax Number	:	954-318-6604

Provider Business Practice Location Address
First Line	:	2295 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3611
Country	:	US
Telephone Number	:	954-983-1969
Fax Number	:	954-983-1980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	05/29/2014

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