Provider Demographics
NPI:1487802179
Name:ERIK C LILJA DPM PLLC
Entity type:Organization
Organization Name:ERIK C LILJA DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LILJA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-527-4177
Mailing Address - Street 1:9501 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2108
Mailing Address - Country:US
Mailing Address - Phone:206-527-4177
Mailing Address - Fax:206-527-2850
Practice Address - Street 1:9501 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2108
Practice Address - Country:US
Practice Address - Phone:206-527-4177
Practice Address - Fax:206-527-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO0000746213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6313670001Medicare NSC