MEDICARE: ROBERT L LILJEBERG JR. M.D.

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	207X00000X	Orthopaedic Surgery Physician	9400564	NC
2	207X00000X	Orthopaedic Surgery Physician	32893	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2202392	OTHER	AL	MEDICARE PROVIDER NUMBER

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659327526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L LILJEBERG JR. M.D.

Provider Business Mailing Address
First Line	:	1330 HIGHWAY 231 S
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36081-3058
Country	:	US
Telephone Number	:	334-670-5474
Fax Number	:	334-670-5446

Provider Business Practice Location Address
First Line	:	1340 HIGHWAY 231 S
Second Line	:	SUITE 6
City	:	TROY
State	:	AL
Zip	:	36081-3011
Country	:	US
Telephone Number	:	334-670-5474
Fax Number	:	334-670-5446

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/03/2017

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