Provider Demographics
NPI:1427165422
Name:LILLY, BRAD H (DPM)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:H
Last Name:LILLY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4812
Mailing Address - Country:US
Mailing Address - Phone:610-821-0444
Mailing Address - Fax:610-820-7006
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4812
Practice Address - Country:US
Practice Address - Phone:610-821-0444
Practice Address - Fax:610-820-7006
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004243L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA013746OtherHIGHMARK BLUE SHIELD
0659158000OtherINDEPENCE BLUE CROSS
50003290OtherCAPITAL BLUE CROSS
PA013746Medicare PIN
0659158000OtherINDEPENCE BLUE CROSS
U71437Medicare UPIN