Provider Demographics
NPI:1619451150
Name:LILJEGREN, MICHAEL THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:LILJEGREN
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7943 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5409
Mailing Address - Country:US
Mailing Address - Phone:251-633-0123
Mailing Address - Fax:251-445-3722
Practice Address - Street 1:7943 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5409
Practice Address - Country:US
Practice Address - Phone:251-633-0123
Practice Address - Fax:251-445-3722
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant