Individual
DR. EMMANUEL MICHAEL ILLICAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, FRCSC
Contact information
Practice address
450 CLARKSON AVE, BROOKLYN, NY 11203-2012
(718) 270-8995
(718) 270-1309
Mailing address
450 CLARKSON AVE, BOX 30, BROOKLYN, NY 11203-2012
(718) 270-3200
(718) 270-2756
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
278062-1
NY
Other
Enumeration date
03/10/2015
Last updated
04/08/2016
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