Individual
JOSEPH R LILJENQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2210 CORONADO ST, IDAHO FALLS, ID 83404
(208) 522-3355
(208) 522-6019
Mailing address
2210 CORONADO ST, IDAHO FALLS, ID 83404
(208) 522-3355
(208) 522-6019
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
3587652
OH
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
M9781
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807709400
—
ID
Enumeration date
07/27/2006
Last updated
09/01/2021
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