Provider Demographics
NPI:1023053303
Name:ILLIG, KARL ARMISTEAD (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:ARMISTEAD
Last Name:ILLIG
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:PO BOX 917770
Mailing Address - Street 2:USF VASCULAR SURGERY
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:813-259-0921
Mailing Address - Fax:813-259-0606
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:USF VASCULAR SURGERY STE.300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-0921
Practice Address - Fax:813-259-0606
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1111622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14H55OtherBLUE CROSS BLUE SHIELD
FL004120700Medicaid
FL14H55OtherBLUE CROSS BLUE SHIELD
FLFP462ZMedicare PIN