Individual
DR. JOHN LILLEGRAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 FAIRFAX AVE, NORFOLK, VA 23507-1914
(757) 446-5955
Mailing address
12007 WINWOOD LN, HOUSTON, TX 77024-5014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0116037328
VA
207Q00000X
Family Medicine Physician
MD-24592
HI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/23/2021
Last updated
04/30/2025
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