Individual
MRS. DESSISLAVA DIMOTROVA ILIEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF ANESTHESIOLOGY, SUITE S108-A, JACKSON, MS 39216
(601) 984-5936
(601) 984-5939
Mailing address
2500 NORTH STATE STREET, DEPARTMENT OF ANESTHESIOLOGY, SUITE S108-A, JACKSON, MS 39216
(601) 984-5936
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
24023
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03620888
—
MS
Enumeration date
12/04/2006
Last updated
10/15/2015
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