Provider Demographics
NPI:1851317440
Name:ISRAEL, LILLIAN LYLE (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:LYLE
Last Name:ISRAEL
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 1:2409 ACTON RD
Mailing Address - Street 2:SUITE 171
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2940
Mailing Address - Country:US
Mailing Address - Phone:205-978-8245
Mailing Address - Fax:205-978-8249
Practice Address - Street 1:2409 ACTON ROAD
Practice Address - Street 2:SUITE 171
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2938
Practice Address - Country:US
Practice Address - Phone:205-978-8245
Practice Address - Fax:205-978-8249
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00004466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12-20178OtherUNITED HEALTHCARE
AL1466OtherHEALTHSPRING
AL000079619Medicaid
AL4063407OtherAETNA
AL51079619OtherBLUE CROSS BLUE SHIELD
ALC79105OtherVIVA HEALTH
AL000079619Medicaid