Provider Demographics
NPI:1164703088
Name:CHAMORRO, LILL E (MD)
Entity Type:Individual
Prefix:
First Name:LILL
Middle Name:E
Last Name:CHAMORRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:307 SE YARDLEY TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2140
Mailing Address - Country:US
Mailing Address - Phone:315-506-0386
Mailing Address - Fax:
Practice Address - Street 1:4500 W MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4823
Practice Address - Country:US
Practice Address - Phone:772-672-8400
Practice Address - Fax:772-467-4135
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1289842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry