Provider Demographics
NPI:1902033905
Name:ACEVEDO, ILEANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:M
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12780 RACE TRACK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1306
Mailing Address - Country:US
Mailing Address - Phone:813-792-9541
Mailing Address - Fax:813-443-8170
Practice Address - Street 1:12780 RACE TRACK RD STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1306
Practice Address - Country:US
Practice Address - Phone:813-792-9541
Practice Address - Fax:813-443-8170
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101875700Medicaid