Provider Demographics
NPI:1114182979
Name:ICLI, TOLGA (MD)
Entity Type:Individual
Prefix:DR
First Name:TOLGA
Middle Name:
Last Name:ICLI
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 1:1450 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4085
Mailing Address - Country:US
Mailing Address - Phone:330-799-8752
Mailing Address - Fax:330-799-8754
Practice Address - Street 1:1450 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4085
Practice Address - Country:US
Practice Address - Phone:330-799-8752
Practice Address - Fax:330-799-8754
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 097338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine