Provider Demographics
NPI:1518084656
Name:ILIOSKA, DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:ILIOSKA
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 1:320 PARK 40 NORTH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3624
Mailing Address - Country:US
Mailing Address - Phone:865-692-3462
Mailing Address - Fax:865-692-3463
Practice Address - Street 1:320 PARK 40 NORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3624
Practice Address - Country:US
Practice Address - Phone:865-692-3462
Practice Address - Fax:865-692-3463
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086246207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4985417Medicaid
MIM54550Medicare PIN
MIM54550019Medicare Oscar/Certification