Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | AL34690 | SC |
N | 207RX0202X | Medical Oncology | G84932 | CA |
NPI | 1033147186 |
---|---|
Provider Name | Michael Brian Lilly |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G849320 | (05) | CA |
C73622 | (02) |