Dr. Lillian K. Ivansco M.D., M.P.H.
Diagnostic Radiology Physician in Atlanta, GA(View on Map)
Full Name
Dr. Lillian Kim Ivansco M.D., M.P.H.
NPI Number
1043478605
NPI Type
Individual Provider
Gender
Female
Enumeration Date
05/29/2008
Specialties
(Taxonomies)Licenses
State
Colorado
Georgia
Hawaii
Kansas
Nebraska
License Number
53370
069869
MD17668
04-37114
27713
Contact
Information
Purpose
Mailing
Location
Address
3495 PIEDMONT RD NE
20 GLENLAKE PKWY
City
Atlanta
Atlanta
State
GA
GA
Postal Code
30305-1717
30328-3473
Country
US
US
Telephone Number
(404) 364-7285
(404) 364-7285
Identifiers
Identifier
10026277500
10026277600
10026277700
10026277300
10026277400
10026277800
1043478605
66229006
929695
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Identifier State
NE
NE
NE
NE
NE
NE
IA
NM
AZ
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Identifier Issuer
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Health Information Exchange
Endpoint Type
SOAP
Endpoint
https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq
Endpoint Description
Carequality
Use
Health Information Exchange (HIE)
Content Type
Other
Other Description:C-CDA
Affiliation
Y
Endpoint Location
Permanente Medical Group20 Glenlake PkwyAtlanta, GA303283473US
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 01/10/2022