Provider Demographics
NPI:1023218328
Name:GARCIA, LILLIAM MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAM
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
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:PO BOX 23158
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-3158
Mailing Address - Country:US
Mailing Address - Phone:954-522-8561
Mailing Address - Fax:954-522-6602
Practice Address - Street 1:935 INTRACOASTAL DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3623
Practice Address - Country:US
Practice Address - Phone:954-522-8561
Practice Address - Fax:954-522-6602
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99240207R00000X
PR14602208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000337600Medicaid
FLH59179Medicare UPIN