Individual
MICHAEL JOHN LILLESTOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1707 GOLD DR, STE 101, FARGO, ND 58103-6413
(701) 280-2033
(701) 232-5578
Mailing address
1707 GOLD DR, STE 101, FARGO, ND 58103-6413
(701) 280-2033
(701) 232-5578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4830
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-12025
MEDICA
—
01
—
1008297
PREFERRED ONE
—
01
—
116742
UCARE
—
05
—
14165
—
ND
01
—
141875400
FEDERAL WORKERS COMP
—
01
—
162D9LI
MINNESOTA BLUE SHIELD
ND
01
—
21574
ND BLUE SHIELD
ND
05
—
663288200
—
MN
01
—
D26082
ND WORKERS COMP
ND
01
—
ND4830
CHAMPUS
—
Enumeration date
05/25/2006
Last updated
08/27/2010
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