Healthcare Provider Details

I. General information

NPI: 1467535112
Provider Name (Legal Business Name): RAUL IVAN VILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 75TH AVE
MIAMI FL
33155-2805
US

IV. Provider business mailing address

3450 BUSCHWOOD PARK DR STE 150
TAMPA FL
33618-4465
US

V. Phone/Fax

Practice location:
  • Phone: 305-264-5252
  • Fax: 305-266-1290
Mailing address:
  • Phone: 813-935-8501
  • Fax: 813-935-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME0049181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: