Healthcare Provider Details

I. General information

NPI: 1467533067
Provider Name (Legal Business Name): DR. LILI LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 CROOKS RD SUITE C
TROY MI
48084-4717
US

IV. Provider business mailing address

2877 CROOKS RD SUITE C
TROY MI
48084-4717
US

V. Phone/Fax

Practice location:
  • Phone: 248-816-1420
  • Fax: 248-816-0579
Mailing address:
  • Phone: 248-816-1420
  • Fax: 248-816-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4030167832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: