Provider Demographics
NPI:1154538080
Name:GRILLY, LISA GAIL (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:GRILLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1500 E MEDICAL CENTER DR
Mailing Address - Street 2:1H247
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-0999
Mailing Address - Country:US
Mailing Address - Phone:734-936-4280
Mailing Address - Fax:734-936-9091
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:1H247
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0999
Practice Address - Country:US
Practice Address - Phone:734-936-4280
Practice Address - Fax:734-936-9091
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2013-11-22
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Provider Licenses
StateLicense IDTaxonomies
MI4301089728207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology