Basic Information
Provider Information
NPI: 1275689341
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABBO
FirstName: LILIAN
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1120 NW 14TH ST
Address2: SUITE 864
City: MIAMI
State: FL
PostalCode: 331362107
CountryCode: US
TelephoneNumber: 3052434598
FaxNumber: 3052434037
Practice Location
Address1: 1120 NW 14TH ST
Address2: SUITE 864
City: MIAMI
State: FL
PostalCode: 331362107
CountryCode: US
TelephoneNumber: 3052434598
FaxNumber: 3052434037
Other Information
ProviderEnumerationDate: 01/25/2007
LastUpdateDate: 02/12/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XME92961FLY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

ID Information
IDTypeStateIssuerDescription
27853400005FL MEDICAID
9576701FLBLUE CROSS BLUE SHIELDOTHER


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