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General NPI Number Information
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NPI Number | 1417925967
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Entity Type | Individual
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Provider Name | VLADIMIR ILIC MD
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Gender | Male
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 13340 METRO PARKWAY SUITE 200
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City | FORT MYERS
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State | FL
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Zip | 33966-4703
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Country | US
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Telephone | 239-343-0550
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Fax | 239-343-0559
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-0550
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Fax | 239-343-4013
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME91534
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME91534
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License Number State | FL
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