Provider Demographics
NPI:1851565022
Name:ILIE, CAMELIA CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:CAMELIA
Middle Name:CARMEN
Last Name:ILIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAMELIA
Other - Middle Name:CARMEN
Other - Last Name:ANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0001
Mailing Address - Country:US
Mailing Address - Phone:701-234-1113
Mailing Address - Fax:701-234-2045
Practice Address - Street 1:222 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-323-5422
Practice Address - Fax:701-323-8645
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12365207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16971Medicaid