Provider Demographics
NPI:1376639492
Name:LILLEY, JAMES M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:LILLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:624 S. CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2009
Mailing Address - Country:US
Mailing Address - Phone:818-241-3369
Mailing Address - Fax:818-242-0640
Practice Address - Street 1:624 S. CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2009
Practice Address - Country:US
Practice Address - Phone:818-241-3369
Practice Address - Fax:818-242-0640
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG148172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39348Medicare UPIN