Female

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)

Code

2085R0202X

Primary Taxonomy

Yes

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

Provider Address

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