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General NPI Number Information
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NPI Number | 1386744514
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Entity Type | Organization
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Legal Business Name | PATRICIO A. ILABACA, MD, PC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 6027 WALNUT GROVE RD SUITE 114
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City | MEMPHIS
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State | TN
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Zip | 38120-2145
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Country | US
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Telephone | 901-683-6161
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Fax | 901-683-7998
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Provider Business Mailing Address
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Address Line | 6027 WALNUT GROVE RD SUITE 114
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City | MEMPHIS
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State | TN
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Zip | 38120-2145
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Country | US
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Telephone | 901-683-6161
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Fax | 901-683-7998
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICIO A. ILABACA
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Credential | MD
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Telephone | 901-683-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 9582
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License Number State | TN
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