Healthcare Provider Details

I. General information

NPI: 1205800489
Provider Name (Legal Business Name): LILLIAM I. ORTIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 NW WASHINGTON BLVD STE A
HAMILTON OH
45013-6367
US

IV. Provider business mailing address

300 HIGH ST FL 3
HAMILTON OH
45011-6078
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax:
Mailing address:
  • Phone: 513-454-1460
  • Fax: 740-289-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-062465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: