Healthcare Provider Details

I. General information

NPI: 1235780073
Provider Name (Legal Business Name): AHMET TURAN ILICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8932 SW 97TH AVE
MIAMI FL
33176-1936
US

IV. Provider business mailing address

8932 SW 97TH AVE
MIAMI FL
33176-1936
US

V. Phone/Fax

Practice location:
  • Phone: 917-769-8140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME165585
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME165585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: