Healthcare Provider Details

I. General information

NPI: 1326099656
Provider Name (Legal Business Name): LILY J LOU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

3340 PROVIDENCE DR SUITE 366
ANCHORAGE AK
99508-4616
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7416
  • Fax:
Mailing address:
  • Phone: 907-563-3026
  • Fax: 907-562-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036154581
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036154581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: