MEDICARE: SIMON LILLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301015057	MI

General Provider Information

NPI Number	:	1306110556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON LILLEY

Provider Business Mailing Address
First Line	:	2814 DAVISON AVE
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2030
Country	:	US
Telephone Number	:	248-895-1879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 DAVISON AVE
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2030
Country	:	US
Telephone Number	:	248-895-1879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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Directions to “ SIMON LILLEY ” Practice Location

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