Provider Demographics
NPI:1760503999
Name:LILIC, NENAD (MD)
Entity Type:Individual
Prefix:
First Name:NENAD
Middle Name:
Last Name:LILIC
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 1:10411-105TH AVENUE
Mailing Address - Street 2:APT. # 142
Mailing Address - City:EDMONTON
Mailing Address - State:AB
Mailing Address - Zip Code:T5H4R8
Mailing Address - Country:CA
Mailing Address - Phone:780-735-4737
Mailing Address - Fax:
Practice Address - Street 1:ROYAL ALEXANDRA HOSPITAL
Practice Address - Street 2:10240 KINGSWAY
Practice Address - City:EDMONTON
Practice Address - State:AB
Practice Address - Zip Code:T5H3V9
Practice Address - Country:CA
Practice Address - Phone:780-735-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA223319207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology