Healthcare Provider Details

I. General information

NPI: 1972709079
Provider Name (Legal Business Name): LILIANA PATRICIA GARCIA-VARGAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S PILGRIM BLVD
YORKTOWN IN
47396-9250
US

IV. Provider business mailing address

2100 CHERRY HILL DR APT 105
COLUMBIA MO
65203-5923
US

V. Phone/Fax

Practice location:
  • Phone: 765-759-4068
  • Fax:
Mailing address:
  • Phone: 313-574-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301089789
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2010018321
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01071868A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: