Individual
JOHNATHAN BEAU LILJENQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2442 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 522-7310
Mailing address
2442 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 522-7310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
O-1865
ID
Other
Enumeration date
06/05/2020
Last updated
08/02/2023
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