Provider Demographics
NPI:1467533067
Name:LEVY, LILI
Entity Type:Individual
Prefix:DR
First Name:LILI
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 CROOKS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4717
Mailing Address - Country:US
Mailing Address - Phone:248-816-1420
Mailing Address - Fax:248-816-0579
Practice Address - Street 1:2877 CROOKS RD
Practice Address - Street 2:SUITE C
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4717
Practice Address - Country:US
Practice Address - Phone:248-816-1420
Practice Address - Fax:248-816-0579
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI40301678322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301067832OtherSTATE LICENSE