Organization
ICLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GIOVANNI LLIBRE MD (OWNER)
(336) 760-0070
Entity
Organization
Contact information
Practice address
755 HIGHLAND OAKS DR, SUITE 202, WINSTON-SALEM, NC 27103-7106
(336) 760-0070
(336) 760-0017
Mailing address
755 HIGHLAND OAKS DR, SUITE 202, WINSTON-SALEM, NC 27103-7106
(336) 760-0070
(336) 760-0017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9900918
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016XT
BCBS OF NORTH CAROLINA
NC
05
—
5950540
—
NC
Enumeration date
05/16/2006
Last updated
06/18/2009
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