Individual
DR. VAN LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
880 6TH ST S, SUITE 470, SAINT PETERSBURG, FL 33701-4827
(727) 767-4313
(727) 767-4391
Mailing address
PO BOX 863298, ORLANDO, FL 32886-3298
(727) 767-4378
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME0045834
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0694673-00
—
FL
01
—
15902
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/10/2006
Last updated
07/15/2011
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