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General NPI Number Information
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NPI Number | 1093000580
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Entity Type | Individual
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Provider Name | MARK ANTHONY ILKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 200 NORTH ST STE 203
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City | GENEVA
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State | NY
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Zip | 14456-1561
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Country | US
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Telephone | 615-787-5383
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Fax |
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Provider Business Mailing Address
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Address Line | 750 E ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2342
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 290944-1
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License Number State | NY
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