Individual
DR. JOHN E LILJENQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2220 E 25TH ST, IDAHO FALLS, ID 83404-7542
(208) 522-2996
(208) 523-6025
Mailing address
3910 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
(208) 522-2996
(208) 523-3318
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
M4220
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002530600
—
ID
01
—
110008760
RAILROAD MEDICARE
ID
01
—
113798100
WYOMING CONSULTEC EDS
ID
01
—
25852
BLUESHIELD OF IDAHO
ID
01
—
34512
BLUECROSS OF IDAHO
DE
01
—
804012300
HEALTHY CONNECTIONS
ID
Enumeration date
07/30/2005
Last updated
06/02/2010
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