MEDICARE: DR. IGOR TRILISKY 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	2085R0202X	Diagnostic Radiology Physician	125.058222	IL

General Provider Information

NPI Number	:	1952613424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IGOR TRILISKY M.D.

Provider Business Mailing Address
First Line	:	4061 POWDER MILL ROAD, SUITE 200
Second Line	:	MEDSTAR MEDICAL GROUP RADIOLOGY LLC
City	:	CALVERTON
State	:	MD
Zip	:	20705
Country	:	US
Telephone Number	:	301-902-1063
Fax Number	:	301-902-1086

Provider Business Practice Location Address
First Line	:	4061 POWDER MILL ROAD, SUITE 200
Second Line	:	MEDSTAR MEDICAL GROUP RADIOLOGY LLC
City	:	CALVERTON
State	:	MD
Zip	:	20705
Country	:	US
Telephone Number	:	301-902-1063
Fax Number	:	301-902-1086

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

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	08/05/2016

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