Doctor Name: | MR. DONALD L LILES |
NPI Number: | 1225103013 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 420 Medical Park Dr After Hours Clinic Watervliet, MI - 490989237 |
Business Phone Number: | 2694633600 |
Business Fax Number: | 2694633581 |
Mailing Address: | 400 Medical Park Dr, After Hours Clinic WATERVLIET |
State: | MI |
Postal Code: | 490989225 |
Phone Number: | 2694633600 |
Fax Number: | 2694633581 |
NPI Enumeration Date: | 11/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |