Individual
MARTHA HERNANDEZ-ILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5333 N DIXIE HWY, SUITE 110, FORT LAUDERDALE, FL 33334
(954) 229-7030
(954) 229-0963
Mailing address
10873 NW 73 TERR, DORAL, FL 33178
(305) 594-5793
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
ME 87694
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01605
BCBS
FL
01
—
P00215148
RAILROAD MEDICARE
—
Enumeration date
07/28/2006
Last updated
07/08/2007
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