Healthcare Provider Details

I. General information

NPI: 1023053303
Provider Name (Legal Business Name): KARL ARMISTEAD ILLIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR USF VASCULAR SURGERY STE.300
TAMPA FL
33606-3603
US

IV. Provider business mailing address

PO BOX 917770 USF VASCULAR SURGERY
ORLANDO FL
32891-7770
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-0921
  • Fax: 813-259-0606
Mailing address:
  • Phone: 813-259-0921
  • Fax: 813-259-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME111162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: