Provider Demographics
NPI:1013448927
Name:ILIESCU, RADU GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:RADU
Middle Name:GABRIEL
Last Name:ILIESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36400 WOODWARD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0913
Mailing Address - Country:US
Mailing Address - Phone:248-702-4177
Mailing Address - Fax:248-957-1490
Practice Address - Street 1:36400 WOODWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0913
Practice Address - Country:US
Practice Address - Phone:248-702-4177
Practice Address - Fax:248-957-1490
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43015038872084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry