Provider Demographics
NPI:1952505141
Name:ALHILALI, LEA MARCIE (MD)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MARCIE
Last Name:ALHILALI
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:PO BOX 44037
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-4037
Mailing Address - Country:US
Mailing Address - Phone:602-954-6882
Mailing Address - Fax:602-975-6142
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-954-6228
Practice Address - Fax:602-957-6142
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4416562085N0700X, 2085R0202X
AZ420742085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ525980Medicaid
PA102551180Medicaid
PA203923Medicare PIN