Provider Demographics
NPI:1013947340
Name:PADILLA, LILLIE-MAE (MD)
Entity type:Individual
Prefix:
First Name:LILLIE-MAE
Middle Name:
Last Name:PADILLA
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 1:8807 JULES LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-9557
Mailing Address - Country:US
Mailing Address - Phone:317-274-7879
Mailing Address - Fax:317-278-9918
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:UH 2440
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-1661
Practice Address - Fax:317-278-9918
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026152A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100060880Medicaid
IN100060880Medicaid
IN896330RMedicare PIN