Healthcare Provider Details

I. General information

NPI: 1285653766
Provider Name (Legal Business Name): CRAIG W LILLEHEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE FEGAN 3
BOSTON MA
02115-5724
US

IV. Provider business mailing address

16 CRAFTSLAND RD
CHESTNUT HILL MA
02467-2632
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-3039
  • Fax: 617-730-0298
Mailing address:
  • Phone: 617-277-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number46255
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number46255
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number46255
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number46255
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: