Mary E Illions-Wilde, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

10132042-1205 Issued in UT

Practice address

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522

Phone

(763) 236-6000

Fax

(763) 236-3433

NPI assigned

Mar 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary E Illions Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Pediatrics LLC

  • Specialist
  • Hurricane, UT
  • NPI 1255803920
  NPD (past)

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1144289604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 N MALL DR STE B201",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907310",
            "telephone_number": "432-222-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332522",
            "telephone_number": "763-236-6000",
            "fax_number": "763-236-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLIONS-WILDE",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-22",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "10132042-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "ILLIONS",
            "middle_name": "E",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Margo Hamlin Hutchison, M.D.
• Dang Q Huynh, CNP
• Joanne M Hynes, RN, NP
• Amanda Ihry
• Kyle Ross Ihry, PHARM D
• Lavanya Rekha Inampudi, DDS
• Infinite Health Collaborative, PA
• Infinite Health Collaborative, PA
• Megan Ingebretson, RD
• Thomas Steven Ingebrigtsen, PA-C

• All providers in Coon Rapids, MN
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.