Provider Demographics
NPI:1700810348
Name:NEELY, ILEY COLEMAN (MD)
Entity type:Individual
Prefix:
First Name:ILEY
Middle Name:COLEMAN
Last Name:NEELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31796
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33631-3796
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7350
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:STE 115
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-771-4271
Practice Address - Fax:954-776-5959
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57956207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180033429OtherRAILROAD MEDICARE
FL10480OtherBCBS
591932202OtherHUMANA
0400878OtherGHI
5443058OtherAETNA
0800138OtherUNITED HEALTHCARE
10480UMedicare PIN
FLF00122Medicare UPIN
0800138OtherUNITED HEALTHCARE