Provider Demographics
NPI:1386894277
Name:MEISAMY, LILI (DO)
Entity type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:MEISAMY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:12221 MERIT DR STE 450
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2294
Practice Address - Country:US
Practice Address - Phone:972-770-1032
Practice Address - Fax:469-484-2126
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN13952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX124969OtherMEDICARE PTAN
TX8DS287OtherBCBS
TX320342401Medicaid
TXTX124969OtherMEDICARE PTAN
TX284539YKPWMedicare PIN