Healthcare Provider Details

I. General information

NPI: 1457115438
Provider Name (Legal Business Name): LILAC HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 S HIGLEY RD STE 101
GILBERT AZ
85296-4777
US

IV. Provider business mailing address

655 S DOBSON RD STE 101
CHANDLER AZ
85224-5668
US

V. Phone/Fax

Practice location:
  • Phone: 480-571-1554
  • Fax:
Mailing address:
  • Phone: 480-459-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN M HOUSLEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 480-571-3737