Individual
MR. BUDDY WAYNE LILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 MAIN STREET, SUITE 230, NEW BRIGHTON, MN 55112
(612) 326-7558
(612) 454-2087
Mailing address
550 MAIN STREET, SUITE 230, NEW BRIGHTON, MN 55112
(612) 326-7558
(612) 454-2087
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
042-0010705
VT
2084P0800X
Psychiatry Physician
Primary
49329
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042-0010705
VERMONT STATE LICENSE
VT
05
—
1010386
—
MN
05
—
1010386
—
VT
Enumeration date
07/07/2006
Last updated
03/07/2023
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