Healthcare Provider Details

I. General information

NPI: 1023329992
Provider Name (Legal Business Name): LILIAN ENYONAM AHIABLE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILIAN ENYONAM AHEDOR M.D

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 1ST AVE S
ST PETERSBURG FL
33707-1223
US

IV. Provider business mailing address

25941 US HIGHWAY 19 N UNIT 14808
CLEARWATER FL
33766-7025
US

V. Phone/Fax

Practice location:
  • Phone: 727-300-2282
  • Fax: 727-321-2680
Mailing address:
  • Phone: 727-300-2282
  • Fax: 727-321-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME135378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: