Healthcare Provider Details

I. General information

NPI: 1285879155
Provider Name (Legal Business Name): CHRISTIAN GEORG LILJE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE PED. CARDIOLOGY, CHILDREN'S HOSPITAL
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

200 HENRY CLAY AVE PED. CARDIOLOGY, CHILDREN'S HOSPITAL
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-2147
  • Fax:
Mailing address:
  • Phone: 504-896-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number202617
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: