Provider Demographics
NPI:1902891054
Name:VILA, ILEANA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:A
Last Name:VILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE E-214
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6741
Mailing Address - Country:US
Mailing Address - Phone:954-318-6590
Mailing Address - Fax:954-318-6604
Practice Address - Street 1:2295 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-983-1969
Practice Address - Fax:954-983-1980
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376254800Medicaid
FLF90806Medicare UPIN
FLF90806Medicare UPIN