Healthcare Provider Details

I. General information

NPI: 1568384741
Provider Name (Legal Business Name): LILY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W DIVERSEY PKWY STE 211
CHICAGO IL
60614-3427
US

IV. Provider business mailing address

2828 N CLARK ST STE 3
CHICAGO IL
60657-5231
US

V. Phone/Fax

Practice location:
  • Phone: 773-324-1172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA BELLA MCCORMICK
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 773-324-1172