Healthcare Provider Details

I. General information

NPI: 1407255540
Provider Name (Legal Business Name): ANNA K LILLIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA K HAMON PA-C

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 519
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 519
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-938-6161
  • Fax: 630-938-6186
Mailing address:
  • Phone: 630-938-6161
  • Fax: 630-938-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005137
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: