Provider Demographics
NPI:1720429251
Name:MARGARETE LILES LLC
Entity Type:Organization
Organization Name:MARGARETE LILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARETE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:586-754-5262
Mailing Address - Street 1:8611 MCKINLEY
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5130 COOLIDGE HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1001
Practice Address - Country:US
Practice Address - Phone:248-658-0878
Practice Address - Fax:248-435-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159463367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty