=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760481592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA ANN LILLIS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2005
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2515 CANAL ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70119-6435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-821-2601
-----------------------------------------------------
Fax | 888-736-9806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 136 S ROMAN ST THIRD FLOOR
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70112-3095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-903-5401
-----------------------------------------------------
Fax | 504-568-5764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 024301
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------