MEDICARE: JOSEPH J ILLIG M.D.

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
1	207T00000X	Neurological Surgery Physician	31907	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1639171549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH J ILLIG M.D.

Provider Business Mailing Address
First Line	:	2312 N NEVADA AVE
Second Line	:	SUITE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-5302
Country	:	US
Telephone Number	:	719-473-3272
Fax Number	:	719-389-1191

Provider Business Practice Location Address
First Line	:	2312 N NEVADA AVE
Second Line	:	SUITE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-5302
Country	:	US
Telephone Number	:	719-473-3272
Fax Number	:	719-389-1191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/18/2013

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