Healthcare Provider Details

I. General information

NPI: 1205147451
Provider Name (Legal Business Name): ERICA LILLIAN STILL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15673 WOOD RD
LANSING MI
48906-1740
US

IV. Provider business mailing address

15673 WOOD RD
LANSING MI
48906-1740
US

V. Phone/Fax

Practice location:
  • Phone: 517-974-1364
  • Fax:
Mailing address:
  • Phone: 517-974-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101018590
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: