Individual
FERNANDO F. ILLESCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 COTTAGE GROVE RD STE E110, BLOOMFIELD, CT 06002-3085
(860) 265-2529
(860) 463-9562
Mailing address
701 COTTAGE GROVE RD STE E110, BLOOMFIELD, CT 06002-3085
(860) 519-0620
(860) 904-2463
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
031371
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001313717
—
CT
01
—
010031371CT01
ANTHEM BC/BS
CT
05
—
1417933961
—
CT
01
—
A2516306
OXFORD
CT
Enumeration date
12/16/2005
Last updated
05/03/2018
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