Provider Demographics
NPI:1790927945
Name:LILY INTERNAL MEDICINE AND ASSOCIATES,LLC
Entity Type:Organization
Organization Name:LILY INTERNAL MEDICINE AND ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:AFAM
Authorized Official - Last Name:UDEZULU
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:302-632-7610
Mailing Address - Street 1:2720 FAST LANDING RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3105
Mailing Address - Country:US
Mailing Address - Phone:302-736-8877
Mailing Address - Fax:302-736-1047
Practice Address - Street 1:1019 MATTLIND WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5369
Practice Address - Country:US
Practice Address - Phone:302-424-1000
Practice Address - Fax:866-662-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007397261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty