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NPI Code Detail

MEDICARE: DR. ILIYA UDLER D.O.

MEDICARE: DR. ILIYA UDLER D.O.
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
1207R00000XInternal Medicine Physician3815TN
2208M00000XHospitalist Physician25169MS
3207R00000XInternal Medicine Physician25169MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447662861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ILIYA UDLER D.O.
Provider Business Mailing Address
First Line : 734B SHERWOOD DR
Second Line :
City : JACKSON
State : MS
Zip : 39216-3303
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1850 CHADWICK DR
Second Line :
City : JACKSON
State : MS
Zip : 39204-3404
Country : US
Telephone Number : 601-376-2832
Fax Number : 601-936-1260
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2014
Last Update Date : 01/02/2026

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Directions to “ DR. ILIYA UDLER D.O.” Practice Location

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