Provider Demographics
NPI:1972709079
Name:GARCIA-VARGAS, LILIANA PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:PATRICIA
Last Name:GARCIA-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 1:2100 CHERRY HILL DR
Mailing Address - Street 2:APT 105
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5923
Mailing Address - Country:US
Mailing Address - Phone:313-574-4399
Mailing Address - Fax:
Practice Address - Street 1:1420 S PILGRIM BLVD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-9250
Practice Address - Country:US
Practice Address - Phone:765-759-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089789207R00000X
MO2010018321207RE0101X
IN01071868A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01761657OtherRR MEDICARE PTAN
IN201143770Medicaid
INM22404007Medicare PIN