Individual
LILLY S BONTRAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1800 E 5TH ST STE 1, DELPHOS, OH 45833-9180
(419) 692-5611
(419) 695-9401
Mailing address
PO BOX 636930, CINCINNATI, OH 45263-6930
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01061077A
IN
207Q00000X
Family Medicine Physician
Primary
35137291
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000039572
MPLAN
—
01
—
000000518581
BLUE CROSS BLUE SHIELD
—
01
—
000000665045
ANTHEM
IN
05
—
200803540
—
IN
01
—
22313
PHYSICIANS HEALTH PLAN
—
01
—
P00465447
RAILROAD MEDICARE
IN
Enumeration date
08/10/2006
Last updated
07/06/2020
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