Organization
CHARLES J LILLY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J LILLY MD (DOCTOR)
(989) 772-3886
Entity
Organization
Contact information
Practice address
2890 HEALTH PARKWAY, MOUNT PLEASANT, MI 48858
(989) 772-3886
(989) 773-6267
Mailing address
2890 HEALTH PARKWAY, MOUNT PLEASANT, MI 48858
(989) 772-3886
(989) 773-6267
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301048544
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0370822
BLUE CROSS BLUE SHIELD
MI
05
—
1644906
—
MI
Enumeration date
08/01/2007
Last updated
09/30/2008
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