Individual
IDLJONA GLLAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4211 VAN DYKE RD STE 200, LUTZ, FL 33558-8005
(813) 321-6237
(813) 463-1801
Mailing address
2995 DREW ST, CLEARWATER, FL 33759-3012
(727) 315-7496
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
ME130716
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020921500
—
FL
01
—
IZ200Z
MEDICARE
FL
Enumeration date
06/15/2014
Last updated
02/02/2024
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