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Organization
ILKO FAMILY MEDICINE PA
Active
Organization
ILKO FAMILY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RYAN (MANAGER)
(815) 834-7200
Entity
Organization
Contact information
Practice address
1687 WOODLANE DR, SUITE 102, WOODBURY, MN 55125-3045
(651) 209-6685
(651) 209-1680
Mailing address
PO BOX 25530, WOODBURY, MN 55125-0530
(651) 209-6685
(651) 209-1680
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ9584
MEDICARE RR
MN
Enumeration date
07/07/2008
Last updated
02/02/2009
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