Organization
LILLY AESTHETICS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERCY ODUEYUNGBO MD (PRESIDENT)
(630) 317-7338
Entity
Organization
Contact information
Practice address
2500 S HIGHLAND AVE STE 220, LOMBARD, IL 60148-7103
(630) 317-7338
Mailing address
PO BOX 644, MARQUETTE, MI 49855-0644
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Enumeration date
12/23/2019
Last updated
12/23/2019
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