MEDICARE: DR. PATRICIA K LILLIS 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	207RX0202X	Medical Oncology Physician	GFE68333	CA
2	2085R0001X	Radiation Oncology Physician	GFE68333	CA

General Provider Information

NPI Number	:	1619960507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA K LILLIS MD

Provider Business Mailing Address
First Line	:	2148 WALBASH DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1383
Country	:	US
Telephone Number	:	334-239-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2148 WALBASH DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1383
Country	:	US
Telephone Number	:	334-239-8580
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	09/11/2025

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