MEDICARE: HELEN LILJENWALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	V3901	TX

General Provider Information

NPI Number	:	1134706674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN LILJENWALL MD

Provider Business Mailing Address
First Line	:	5232 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8589
Country	:	US
Telephone Number	:	214-456-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	5232 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8589
Country	:	US
Telephone Number	:	214-456-4586
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	11/11/2024

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