MEDICARE: LARRY J LILLY 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	208600000X	Surgery Physician	35039979	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497791180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY J LILLY MD

Provider Business Mailing Address
First Line	:	5450 FRANTZ RD STE 360
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-4141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 THOMAS LN STE 3A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1419
Country	:	US
Telephone Number	:	614-566-4510
Fax Number	:

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	01/05/2022

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Directions to “ LARRY J LILLY MD” Practice Location

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