Individual
PAUL RANDALL LILLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4204 GARDENDALE ST, SUITE 312, SAN ANTONIO, TX 78229-3132
(504) 952-4440
Mailing address
26516 AVOYELLES AVE, DENHAM SPRINGS, LA 70726-6972
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
P8693
TX
Other
Enumeration date
03/18/2011
Last updated
04/03/2014
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