Organization
SERGIO ILIC, M.D., PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGIO ILIC M.D. (PRESIDENT)
(559) 324-6504
Entity
Organization
Contact information
Practice address
264 CLOVIS AVE, SUITE 207, CLOVIS, CA 93612-1115
(559) 324-6504
Mailing address
4910 E CLINTON WAY, SUITE 101, FRESNO, CA 93727-1560
(559) 453-5203
(559) 453-3321
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A31668
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A316681
—
CA
Enumeration date
03/22/2007
Last updated
08/22/2020
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