Basic Information
Provider Information
NPI: 1669411260
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LILJEBLAD
FirstName: EILEEN
MiddleName: AYE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SEIN
OtherFirstName: AYE AYE
OtherMiddleName: TIN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 5
Mailing Information
Address1: PO BOX 5980
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794085980
CountryCode: US
TelephoneNumber: 8067758400
FaxNumber:  
Practice Location
Address1: 602 INDIANA AVENUE
Address2:  
City: LUBBOCK
State: TX
PostalCode: 79415
CountryCode: US
TelephoneNumber: 8067758400
FaxNumber: 8067758412
Other Information
ProviderEnumerationDate: 06/06/2006
LastUpdateDate: 12/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XA33565CAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XF5068TXY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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