Provider Demographics
NPI:1497782858
Name:ILISKOVIC, NATASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:ILISKOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:ILISKOVIC-HOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18450 HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4404
Mailing Address - Country:US
Mailing Address - Phone:281-446-6566
Mailing Address - Fax:281-446-6657
Practice Address - Street 1:18450 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4404
Practice Address - Country:US
Practice Address - Phone:281-446-6566
Practice Address - Fax:281-446-6657
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5772207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82G136OtherBCBS
TX187765601Medicaid
TXH92075Medicare PIN
TXH92075Medicare UPIN