Provider Demographics
NPI:1689664211
Name:DWARKA, LILLMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:LILLMAN
Middle Name:
Last Name:DWARKA
Suffix:
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 1:38300 VAN DYKE
Mailing Address - Street 2:105
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312
Mailing Address - Country:US
Mailing Address - Phone:586-268-3600
Mailing Address - Fax:586-268-3730
Practice Address - Street 1:38300 VAN DYKE
Practice Address - Street 2:105
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312
Practice Address - Country:US
Practice Address - Phone:586-268-3600
Practice Address - Fax:586-268-3730
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034442207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1896270Medicaid
0501731Medicare ID - Type Unspecified
MI1896270Medicaid