Provider Demographics
NPI:1306924915
Name:ILKO, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:ILKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:821 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3025
Mailing Address - Country:US
Mailing Address - Phone:612-802-5253
Mailing Address - Fax:
Practice Address - Street 1:1687 WOODLANE DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3045
Practice Address - Country:US
Practice Address - Phone:651-209-6685
Practice Address - Fax:651-209-1680
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF42611Medicare UPIN