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General NPI Number Information
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NPI Number | 1639446891
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Entity Type | Organization
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Legal Business Name | CHARLES A ILIYA MD PA
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 9330 POPPY DR SUITE 500
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City | DALLAS
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State | TX
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Zip | 75218-4612
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Country | US
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Telephone | 214-321-2481
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Fax | 214-324-1478
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Provider Business Mailing Address
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Address Line | 9330 POPPY DR SUITE 500
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City | DALLAS
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State | TX
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Zip | 75218-4612
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Country | US
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Telephone | 214-321-2481
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Fax | 214-324-1478
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES A ILIYA
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Credential | M.D.
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Telephone | 214-321-2481
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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 | G5202
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G5202
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License Number State | TX
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