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General NPI Number Information
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NPI Number | 1124146337
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Entity Type | Organization
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Legal Business Name | LILL FAMILY MEDICINE CENTER, INC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15325 W 95TH ST
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City | LENEXA
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State | KS
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Zip | 66219-1262
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Country | US
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Telephone | 913-310-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 15325 W 95TH ST
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City | LENEXA
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State | KS
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Zip | 66219-1262
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN R LILL
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Credential | D.O.
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Telephone | 913-310-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05-25763
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License Number State | KS
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