Provider Demographics
NPI:1508581653
Name:ALLAM, LILA (PA)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:
Last Name:ALLAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2616 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3510
Mailing Address - Country:US
Mailing Address - Phone:810-280-3023
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1291
Practice Address - Country:US
Practice Address - Phone:989-723-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant