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General NPI Number Information
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NPI Number | 1457775645
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Entity Type | Individual
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Provider Name | LILLY MICHAEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 9180 PINECROFT DR STE 500
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City | SHENANDOAH
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State | TX
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Zip | 77380-3883
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Country | US
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Telephone | 713-897-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 7521 CEDAR ELM DR
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City | IRVING
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State | TX
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Zip | 75063-8421
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Country | US
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Telephone | 214-517-9771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA08941
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License Number State | TX
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