SERGIO ILIC, M.D., PROFESSIONAL CORPORATION (NPI# 1427175983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427175983 |
| Entity Type | Organization |
| Organization Name | SERGIO ILIC, M.D., PROFESSIONAL CORPORATION |
| Practice Address |
264 Clovis Ave Suite 207 Clovis CA 93612-1115 |
| Mailing Address |
4910 E Clinton Way Suite 101 Fresno CA 93727-1560 |
| Practice Telephone | 5593246504 |
| Mailing Telephone | 5594535203 |
| Mailing Fax Number | 5594533321 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. SERGIO ILIC (PRESIDENT) |
| Authorized Official Telephone | 5593246504 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | A31668 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A316681 | 05 |
| Street Address |
264 CLOVIS AVE SUITE 207 |
| City | CLOVIS |
| State | CA |
| Zip Code | 93612-1115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558307009 | Diane Leigh Ashmore | Counselor | 264 Clovis Ave, Clovis, CA 93612-1115 | 2006-06-22 |
| 1831655075 | Heather Elizabeth Carrier | Marriage & Family Therapist | 264 Clovis Ave, Clovis, CA 93612-1115 | 2019-02-12 |
| 1164958187 | Alicia Marie Negri | Marriage & Family Therapist | 264 Clovis Ave, 213, Clovis, CA 93612-1115 | 2017-05-11 |
| 1528447802 | Tracee Phanco | Marriage & Family Therapist | 264 Clovis Ave, Suite 211, Clovis, CA 93612-1115 | 2015-05-20 |
| 1366830325 | Kaela Stephens | Counselor | 264 Clovis Ave, Clovis, CA 93612-1115 | 2014-12-29 |
| 1952633570 | Jeanne Galbraith | Marriage & Family Therapist | 264 Clovis Ave, Suite 102, Clovis, CA 93612-1115 | 2010-02-06 |
| 1679736250 | David John Wolter | Marriage & Family Therapist | 264 Clovis Ave, Clovis, CA 93612-1115 | 2008-07-03 |
| 1205028685 | Matthew Kelly Malin | Marriage & Family Therapist | 264 Clovis Ave, Ste 212, Clovis, CA 93612-1115 | 2007-08-09 |
| 1235340993 | Patricia L. Sweetman | Social Worker | 264 Clovis Ave, Suite 104, Clovis, CA 93612-1115 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235778002 | Prieto Dental Corporation | Dentist | 2320 Clovis Avenue, Suite 102, Clovis, CA 93612 | 2019-12-27 |
| 1285190827 | Natividad Casillas | Behavior Technician | 20 N Dewitt, Clovis, CA 93612 | 2019-02-19 |
| 1922578988 | Benjamin Harold Davis Jr. | Behavior Technician | Swans Consulting, 20 N Dewitt Ave, Clovis, CA 93612 | 2018-12-03 |
| 1134620651 | Innovative Development & Living Solutions of California | Assisted Living Facility | 32 West Sierra Ave, Clovis, CA 93612 | 2018-02-21 |
| 1427578616 | Mariamajane Sengsiri | Licensed Vocational Nurse | 1244 Estabrook Ave., Clovis, CA 93612 | 2017-06-20 |
| 1417482464 | Tiffanie Guy | Pharmacist | 2810 Willow Ave Apt 206, Clovis, CA 93612 | 2017-04-27 |
| 1194271833 | Daniel Salinas | Specialist/Technologist | 1712 Harvard Ave., Clovis, CA 93612 | 2016-09-01 |
| 1386071447 | Darra Hirsh | Psychologist | 334 Shaw Ave Ste 100, Clovis, CA 93612 | 2013-10-03 |
| 1437400793 | Bashful Elephant | Counselor | 3097 Willow Suite 4, Clovis, CA 93612 | 2012-09-27 |
| 1588930432 | Nghiem Gia Vu | Pharmacist | 695 W Herdn Ave, Clovis, CA 93612 | 2012-03-26 |
| Find all providers in zip 93612 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881762896 | Eric L Pagenkopf | Orthopaedic Surgery | 729 N Medical Center Dr W, Suite 111, Clovis, CA 93611-6879 | 2006-11-30 |
| 1649220435 | Jacob George | Orthopaedic Surgery | 2421 W. 21st Street, Clovis, NM 88101 | 2006-05-11 |
| 1942262555 | Simonian Sports Medicine Clinic A Medical Corporation | Orthopaedic Surgery | 729 North Medical Center Drive West, Suite 101, Clovis, CA 93611-6880 | 2006-04-06 |
| 1124025325 | Eric Michael Lindvall | Orthopaedic Surgery | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2005-07-01 |
| 1962813741 | Lucas Seiler | Orthopaedic Surgery | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2014-05-14 |
| 1689096786 | Michael Charles | Orthopaedic Surgery | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2014-01-09 |
| 1528402179 | Arbi Nazarian | Orthopaedic Surgery | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2013-04-25 |
| 1689961310 | Mark Ayoub | Orthopaedic Surgery | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2011-07-01 |
| 1780976902 | Motasem Refaat | Orthopaedic Surgery | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2011-05-05 |
| 1053600940 | Jason Aaron Davis | Orthopaedic Surgery | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2011-03-31 |
| Find all providers in CLOVIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.