Provider Demographics
NPI:1437130655
Name:LALLISS, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:LALLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4433 CHEVAL WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6369
Mailing Address - Country:US
Mailing Address - Phone:904-662-4446
Mailing Address - Fax:
Practice Address - Street 1:414 G ST STE 120
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5670
Practice Address - Country:US
Practice Address - Phone:530-749-4304
Practice Address - Fax:530-749-6609
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME112470207XX0005X
CAC142801207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine