Ilic Renal and Hypertension Associates, P.a.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

ILIC RENAL AND HYPERTENSION ASSOCIATES, P.A.

Practice address

3825 E Devonshire CT
Bloomington, IN 47408-9699

Phone

(812) 837-3223

NPI assigned

Sep 6, 2019

Last updated

Jun 15, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ljubomir Ilic, MD

Title

President

Phone

(812) 837-3515

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1033768619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 E DEVONSHIRE CT",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474089699",
            "telephone_number": "812-837-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 E DEVONSHIRE CT",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474089699",
            "telephone_number": "812-837-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILIC RENAL AND HYPERTENSION ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-06",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "ILIC",
        "authorized_official_first_name": "LJUBOMIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-837-3515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Hyble, LMFT
• Stephanie Hyten
• I-Care Bloomington Inc
• Ahmed Ibrahim, MD
• Icr Operating Subsidiary, LLC
• Ljubomir M Ilic, MD
• Dwain Clark Illman, M.D.
• Ima East Primary Care
• Ima Inc Laboratory
• Ima, Inc.

• Nephrology Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Nephrology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.