Organization
LILLESTOL RESEARCH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHN LILLESTOL MD (PRESIDENT)
(701) 232-7705
Entity
Organization
Contact information
Practice address
1711 GOLD DR S, SUITE 170, FARGO, ND 58103-6416
(701) 232-7705
(701) 893-9046
Mailing address
1711 GOLD DR S, SUITE 170, FARGO, ND 58103-6416
(701) 232-7705
(701) 893-9046
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R30611
ND
Other
Enumeration date
09/12/2011
Last updated
09/12/2011
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