Individual
DR. MARY ANN LILLIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
6301 E 125TH ST, GRANDVIEW, MO 64030-1884
(913) 660-1616
Mailing address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(913) 660-1616
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
05-28496
KS
207R00000X
Internal Medicine Physician
Primary
1999135661
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100351420B
—
KS
05
—
1902899834
—
MO
05
—
204776215
—
MO
01
—
26231025
BLUE SHIELD KC, MO
MO
01
—
P00345672
RAILROAD MEDICARE
KS
Enumeration date
08/25/2005
Last updated
04/05/2018
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