Individual
DR. DAVID W LILLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1155 N MAYFAIR RD, PLANK ROAD CLINIC, MILWAUKEE, WI 53226-3421
(414) 955-5990
(414) 955-6282
Mailing address
1155 N MAYFAIR RD, PLANK ROAD CLINIC, MILWAUKEE, WI 53226-3421
(414) 955-5990
(414) 955-6282
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22717
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000124S
HUMANA
—
05
—
1083665830
—
WI
05
—
30286700
—
WI
Enumeration date
05/15/2006
Last updated
11/08/2012
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