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Individual

DR. MAUREEN A LILLICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1001 W MAIN ST, SUITE 500A, PEORIA, IL 61606-1276
(309) 672-4980
(309) 671-2944
Mailing address
PO BOX 365, MORTON, IL 61550-0365
(309) 672-4980
(309) 691-2944

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036084518
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
008852
HEALTH ALLIANCE
IL
05
036084518
IL
01
07215152
BLUE CROSS
IL
01
110068683
RAILROAD MEDICARE
IL
01
180607
HEALTHLINK
IL
01
371221637
FEDERAL TAX IDENTIFICATIO
IL
01
4282558
AETNA HEALTH PLANS
IL
01
776530
MEDICARE GROUP NUMBER
IL
01
IL0106
JOHN DEERE
IL
Enumeration date
06/09/2006
Last updated
05/28/2009
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