Individual
KEITH D LILLEMOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1800 ORLEANS ST, BALTIMORE, MD 21287-0010
(410) 502-2037
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 955-5000
(410) 500-4266
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
1058276A
IN
208600000X
Surgery Physician
247458
MA
208600000X
Surgery Physician
Primary
D0024521
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200460210
—
IN
Enumeration date
05/24/2006
Last updated
08/06/2026
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