Provider Demographics
NPI:1033142476
Name:MASSOUMI, LILA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LILA
Middle Name:ELIZABETH
Last Name:MASSOUMI
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:30300 TELEGRAPH RD, SUITE 310
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-468-1889
Mailing Address - Fax:248-419-2453
Practice Address - Street 1:30300 TELEGRAPH RD, SUITE 310
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-468-1889
Practice Address - Fax:248-419-2453
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010796252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM80830009Medicare PIN
MII59896Medicare UPIN