MEDICARE: DR. STEPHANIE ALLEN LILLY MD

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	208600000X	Surgery Physician	13478	NH
2	208600000X	Surgery Physician	ME126331	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538351739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE ALLEN LILLY MD

Provider Business Mailing Address
First Line	:	3810 NORTHDALE BLVD STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1871
Country	:	US
Telephone Number	:	813-996-1331
Fax Number	:	888-850-8316

Provider Business Practice Location Address
First Line	:	2963 GULF TO BAY BLVD STE 270
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4209
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	07/20/2020

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