# LILLESTOL RESEARCH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104108695
- **Authorized official:** MICHAEL JOHN LILLESTOL MD (PRESIDENT)
- **Authorized official phone:** (701) 232-7705

## Contact information

- **Practice address:** 1711 GOLD DR S, SUITE 170, FARGO, ND 58103-6416
- **Practice address phone:** (701) 232-7705
- **Practice address fax:** (701) 893-9046
- **Mailing address:** 1711 GOLD DR S, SUITE 170, FARGO, ND 58103-6416
- **Mailing address phone:** (701) 232-7705
- **Mailing address fax:** (701) 893-9046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | R30611 | ND | Yes |

## Other

- **Enumeration date:** 09/12/2011
- **Last updated:** 09/12/2011