Healthcare Provider Details

I. General information

NPI: 1760503999
Provider Name (Legal Business Name): NENAD LILIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROYAL ALEXANDRA HOSPITAL 10240 KINGSWAY
EDMONTON AB
T5H3V9
CA

IV. Provider business mailing address

10411-105TH AVENUE APT. # 142
EDMONTON AB
T5H4R8
CA

V. Phone/Fax

Practice location:
  • Phone: 780-735-4737
  • Fax:
Mailing address:
  • Phone: 780-735-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number223319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: