Healthcare Provider Details

I. General information

NPI: 1508156803
Provider Name (Legal Business Name): LILY HSIEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 FLETCHER DR STE 302
ELGIN IL
60123-4750
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-6600
  • Fax: 847-695-4279
Mailing address:
  • Phone: 414-955-1450
  • Fax: 414-955-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036150488
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: