Healthcare Provider Details

I. General information

NPI: 1750817243
Provider Name (Legal Business Name): OLESYA ILKUN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

PO BOX 100224
GAINESVILLE FL
32610-0224
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9180
  • Fax: 352-392-5465
Mailing address:
  • Phone: 352-273-9180
  • Fax: 352-392-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME157051
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME157051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: