Provider Demographics
NPI:1336181205
Name:VOLFSON, ILYA A (MD)
Entity type:Individual
Prefix:DR
First Name:ILYA
Middle Name:A
Last Name:VOLFSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:BLDG 13 STE 177
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1683
Mailing Address - Country:US
Mailing Address - Phone:480-394-0200
Mailing Address - Fax:
Practice Address - Street 1:4530 E RAY RD STE 128
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6096
Practice Address - Country:US
Practice Address - Phone:480-394-0200
Practice Address - Fax:480-394-0202
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 428954208800000X
AZ50144208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107136XDKMedicare PIN
PAI29777Medicare UPIN
I29777Medicare UPIN