Provider Demographics
NPI:1558773473
Name:LILE, DEACON (MD)
Entity type:Individual
Prefix:DR
First Name:DEACON
Middle Name:
Last Name:LILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 S SPRING AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:215-707-2000
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 3301
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-7021
Practice Address - Country:US
Practice Address - Phone:302-623-4370
Practice Address - Fax:302-623-4375
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206082208600000X
DEC1-00272272086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care