Healthcare Provider Details

I. General information

NPI: 1609941152
Provider Name (Legal Business Name): STEVEN L LILLEHAUG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST - MS 11502B HEALTHPARTNERS REGIONS SPECIALTY CLINICS 11502B
ST. PAUL MN
55101-2502
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3135
  • Fax: 651-254-3048
Mailing address:
  • Phone: 952-883-5375
  • Fax: 651-254-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number46782
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: