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Individual

JENS JACOB LILLEVOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6401 FRANCE AVE S, EDINA, MN 55435-2104
(612) 873-6963
Mailing address
6401 FRANCE AVE S, EDINA, MN 55435-2104

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
67551
MN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
03/30/2017
Last updated
06/05/2020
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