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NPI Code Detail

MEDICARE: JANE ILUBA MD

MEDICARE: JANE ILUBA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0101XMOHS-Micrographic Surgery Physician33945SC
2207ND0101XMOHS-Micrographic Surgery Physician01073699AIN
3207ND0101XMOHS-Micrographic Surgery Physician93791GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
193791OTHERGAGA MEDICAL LICENSE

General Provider Information

NPI Number : 1447575931
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE ILUBA MD
Provider Business Mailing Address
First Line : 2505 HARRISON AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4464
Country : US
Telephone Number : 772-313-3768
Fax Number : 850-522-5384
Provider Business Practice Location Address
First Line : 658 N CHASE ST # 102
Second Line :
City : ATHENS
State : GA
Zip : 30601-1960
Country : US
Telephone Number : 772-313-3768
Fax Number : 850-522-8354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2010
Last Update Date : 11/28/2022

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