Provider Demographics
NPI:1447338454
Name:TRILLIS, FLOYD JR (MD)
Entity type:Individual
Prefix:
First Name:FLOYD
Middle Name:
Last Name:TRILLIS
Suffix:JR
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 1:29099 HEALTH CAMPUS DR STE 225
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5280
Mailing Address - Country:US
Mailing Address - Phone:440-835-6116
Mailing Address - Fax:440-899-4279
Practice Address - Street 1:29099 HEALTH CAMPUS DR STE 225
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5280
Practice Address - Country:US
Practice Address - Phone:440-835-6116
Practice Address - Fax:440-899-4279
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0642997Medicaid
OH0642997Medicaid
OHA16411Medicare UPIN