Provider Demographics
NPI: | 1477559359 |
---|---|
Name: | HERNANDEZ-ILIZALITURRI, FRANCISCO (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | FRANCISCO |
Middle Name: | |
Last Name: | HERNANDEZ-ILIZALITURRI |
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: | ELM AND CARLTON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BUFFALO |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14263-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 716-845-2300 |
Mailing Address - Fax: | 716-845-3894 |
Practice Address - Street 1: | ELM AND CARLTON ST |
Practice Address - Street 2: | |
Practice Address - City: | BUFFALO |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14263-0001 |
Practice Address - Country: | US |
Practice Address - Phone: | 716-845-2300 |
Practice Address - Fax: | 716-845-3894 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-24 |
Last Update Date: | 2021-02-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 254445 | 207R00000X, 207RX0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 02397184 | Medicaid | |
NY | DD5436 | Medicare PIN | |
NY | 02397184 | Medicaid |