Provider Demographics
NPI:1952627580
Name:LILYQUIST, MICHAEL BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:LILYQUIST
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:9480 DOUBLE DIAMOND PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5845
Mailing Address - Country:US
Mailing Address - Phone:775-786-1600
Mailing Address - Fax:775-786-7706
Practice Address - Street 1:9480 DOUBLE DIAMOND PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5845
Practice Address - Country:US
Practice Address - Phone:775-786-1600
Practice Address - Fax:775-786-7706
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2018-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV16371207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery