Individual
KEITH D LILLEMOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
545 BARNHILL DR, EM 523, INDIANAPOLIS, IN 46202-5112
(317) 274-3086
(317) 278-1886
Mailing address
545 BARNHILL DR, EM 523, INDIANAPOLIS, IN 46202-5112
(317) 274-3086
(317) 278-1886
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
1058276A
IN
208600000X
Surgery Physician
Primary
247458
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200460210
—
IN
Enumeration date
05/24/2006
Last updated
06/16/2011
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