Individual
DR. CHARLES J LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2890 HEALTH PARKWAY, MOUNT PLEASANT, MI 48858
(989) 772-3886
(989) 773-6267
Mailing address
350 CEDAR DR, MOUNT PLEASANT, MI 48858-9027
(989) 772-4403
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301048544
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00370822
BLUE CROSS BLUE SHIELD MI
MI
05
—
1644906
—
MI
Enumeration date
09/26/2006
Last updated
09/30/2008
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