Provider Demographics
NPI:1588083554
Name:LILES, IYANNA ATWELL (MD)
Entity type:Individual
Prefix:
First Name:IYANNA
Middle Name:ATWELL
Last Name:LILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IYANNA
Other - Middle Name:CAMILE
Other - Last Name:ATWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE RM 1026
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1701
Mailing Address - Country:US
Mailing Address - Phone:860-714-4440
Mailing Address - Fax:860-714-8012
Practice Address - Street 1:1000 ASYLUM AVE RM 1026
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1701
Practice Address - Country:US
Practice Address - Phone:860-714-4440
Practice Address - Fax:860-714-8012
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT60228207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology