Individual
DR. LISA CHRISTINE ILLIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-0121
(952) 993-1456
Mailing address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-0121
(952) 993-1456
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
52246
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00554641
—
VA
05
—
005884641
—
VA
01
—
209808
SOUTHERN HEALTH
VA
01
—
278633
ANTHEM SVCS/HEALTHKEEPERS
VA
05
—
278633
—
VA
01
—
2959204001
CIGNA
VA
01
—
64758
COMMUNITY HEALTH
VA
05
—
64758
—
VA
01
—
P00074226
MEDICARE PIN
VA
Enumeration date
06/03/2006
Last updated
10/13/2011
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