Provider Demographics
NPI:1508902099
Name:VARGAS, LILLIAN M (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:M
Last Name:VARGAS
Suffix:
Gender:F
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:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7105
Mailing Address - Fax:407-770-0594
Practice Address - Street 1:1050 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3328
Practice Address - Country:US
Practice Address - Phone:407-483-1400
Practice Address - Fax:407-483-1405
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047210207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002357600Medicaid
FL30725Medicare ID - Type Unspecified
FLD54103Medicare UPIN