Provider Demographics
NPI:1336119783
Name:DECOSIMO, LILLIAN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:MARIE
Last Name:DECOSIMO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1850 W OAK KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6415
Mailing Address - Country:US
Mailing Address - Phone:703-859-5225
Mailing Address - Fax:844-898-2182
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:FETALCARE CENTER/ SPECIAL DELIVERY UNIT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:786-624-3509
Practice Address - Fax:844-898-2182
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2020-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101053044174400000X
FLME131219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024734400Medicaid
VA6201547Medicaid
VA003004Medicare Oscar/Certification