Organization
INTERNAL MEDICINE ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J LILLESTOL MD (PRESIDENT)
(701) 280-2033
Entity
Organization
Contact information
Practice address
4450 31ST AVE S STE 102, FARGO, ND 58104-4557
(701) 280-2033
(701) 232-5578
Mailing address
4450 31ST AVE S STE 102, FARGO, ND 58104-4557
(701) 280-2033
(701) 232-5578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05595001
ND BLUE SHIELD
ND
05
—
11941
—
ND
01
—
162D7IN
MN BLUE SHIELD
MN
05
—
301713300
—
MN
Enumeration date
10/02/2006
Last updated
04/18/2025
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