Provider Demographics
NPI:1588716492
Name:ILAGAN, MARLON (MD)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:ILAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-896-1726
Mailing Address - Fax:407-896-9716
Practice Address - Street 1:1817 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-896-1726
Practice Address - Fax:407-896-9716
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95898207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2758652Medicaid
PAIL740966Medicare ID - Type Unspecified
FL2758652Medicaid
FLAC421YMedicare PIN
FLAC421XMedicare PIN