Lile, Buddy Wayne

Lile, Buddy Wayne is an individual health care provider with primary practice located at 550 Main Street Suite 230, New Brighton MN 55112. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Lile, Buddy Wayne can be contacted via phone (612) 326-7558.

Contact Information

Primary practice address
550 Main Street Suite 230 New Brighton MN 55112
Phone: (612) 326-7558
Fax: (612) 454-2087
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 042-0010705 Vermont
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 49329 Minnesota

Profile Details

NPI number 1104858612
LBN Legal business name Lile, Buddy Wayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2006
Last updated Mar 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104858612 NPPES
Vermont Other 042-0010705 VERMONT STATE LICENSE
Vermont MEDICAID 1010386 VERMONT STATE LICENSE
Vermont MEDICAID 1010386 VERMONT STATE LICENSE

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