Provider Demographics
NPI:1619960507
Name:LILLIS, PATRICIA K (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
Last Name:LILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 WALBASH DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1383
Mailing Address - Country:US
Mailing Address - Phone:334-239-8580
Mailing Address - Fax:
Practice Address - Street 1:2148 WALBASH DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1383
Practice Address - Country:US
Practice Address - Phone:334-239-8580
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE68333207RX0202X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology