Doctor Name: | JAMES S LILLICH |
NPI Number: | 1619969342 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 15579 |
Business Practice Address: | 1500 Line Avenue Ste 100 Shreveport, LA - 71101 |
Business Phone Number: | 3186353052 |
Business Fax Number: | 3186326087 |
Mailing Address: | 1534 Elizabeth Ave, Ste 300b SHREVEPORT |
State: | LA |
Postal Code: | 711014516 |
Phone Number: | 3186295002 |
Fax Number: | 3186295020 |
NPI Enumeration Date: | 08/18/2005 |
NPI Last Update Date: | 05/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207XX0004X |
License Number: | 15579 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Orthopaedic Surgery |
Taxonomy Specialization: | Foot and Ankle Surgery |
Taxonomy Definition: | Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. |