Individual
MICHAEL JOHN LILLESTOL
Active
Individual
MICHAEL JOHN LILLESTOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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