Provider Demographics
NPI:1669411260
Name:LILJEBLAD, EILEEN AYE (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:AYE
Last Name:LILJEBLAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYE AYE
Other - Middle Name:TIN
Other - Last Name:SEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-1428
Mailing Address - Country:US
Mailing Address - Phone:844-466-5613
Mailing Address - Fax:419-223-2726
Practice Address - Street 1:602 INDIANA AVENUE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415
Practice Address - Country:US
Practice Address - Phone:806-775-8400
Practice Address - Fax:806-775-8412
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-01732085R0202X
OH35.1479712085R0202X
CAA335652085R0202X
TXF50682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124937705Medicaid
E88586Medicare UPIN
TX124937705Medicaid