# SERGIO ILIC, M.D., PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427175983
- **Authorized official:** DR. SERGIO ILIC M.D. (PRESIDENT)
- **Authorized official phone:** (559) 324-6504

## Contact information

- **Practice address:** 264 CLOVIS AVE, SUITE 207, CLOVIS, CA 93612-1115
- **Practice address phone:** (559) 324-6504
- **Mailing address:** 4910 E CLINTON WAY, SUITE 101, FRESNO, CA 93727-1560
- **Mailing address phone:** (559) 453-5203
- **Mailing address fax:** (559) 453-3321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A31668 | CA | Yes |

## Other

- **Enumeration date:** 03/22/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A316681 | — | CA |