Individual
DR. POLLY A LILLEBOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
805 OAKLAND STREET, ST JOHNS, MI 48879
(989) 227-3400
Mailing address
1500 S MAIN ST, EATON RAPIDS, MI 48827-1952
(517) 663-9555
(517) 663-3430
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301047563
MI
207P00000X
Emergency Medicine Physician
Primary
430104756
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1728309
—
MI
01
—
382168683
TAX ID
MI
Enumeration date
01/23/2007
Last updated
02/06/2020
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