Provider Demographics
NPI:1790861813
Name:ILIC, IVA SIKIRICA (MD)
Entity Type:Individual
Prefix:
First Name:IVA
Middle Name:SIKIRICA
Last Name:ILIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IVA
Other - Middle Name:
Other - Last Name:SIKIRICA ILIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1060 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3402
Mailing Address - Country:US
Mailing Address - Phone:408-243-6911
Mailing Address - Fax:408-243-6941
Practice Address - Street 1:1060 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3402
Practice Address - Country:US
Practice Address - Phone:408-243-6911
Practice Address - Fax:408-243-6941
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFI0787145OtherDEA