MEDICARE: LILLY WELLNESS CLINIC LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1376313940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILLY WELLNESS CLINIC LLC

Provider Business Mailing Address
First Line	:	6330 BROADWAY BLVD STE C
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 BROADWAY BLVD STE C
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5956
Country	:	US
Telephone Number	:	972-544-0400
Fax Number	:	972-544-0401

Authorized Official
Title or Position	:	MEMBER
Name	:	HARPREET SINGH
Credential	:
Telephone Number	:	901-389-0377

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/16/2024

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Directions to “LILLY WELLNESS CLINIC LLC ” Practice Location

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