Provider Demographics
NPI:1659327526
Name:LILJEBERG, ROBERT L JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:LILJEBERG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 HIGHWAY 231 S
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3058
Mailing Address - Country:US
Mailing Address - Phone:334-670-5474
Mailing Address - Fax:334-670-5446
Practice Address - Street 1:1340 HIGHWAY 231 S
Practice Address - Street 2:SUITE 6
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3011
Practice Address - Country:US
Practice Address - Phone:334-670-5474
Practice Address - Fax:334-670-5446
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400564207X00000X
AL32893207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL155860Medicaid
AL2202392OtherMEDICARE PROVIDER NUMBER
NC8951981Medicaid
AL155860Medicaid
NC2202392AMedicare PIN
AL2202392OtherMEDICARE PROVIDER NUMBER