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General NPI Number Information
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NPI Number | 1306924915
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Entity Type | Individual
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Provider Name | JAMES ILKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 1687 WOODLANE DRIVE SUITE 102
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City | WOODBURY
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State | MN
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Zip | 55125-3045
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Country | US
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Telephone | 651-209-6685
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Fax | 651-209-1680
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Provider Business Mailing Address
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Address Line | 821 REDWOOD DR
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City | FAIRMONT
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State | MN
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Zip | 56031-3025
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Country | US
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Telephone | 612-802-5253
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35700
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License Number State | MN
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