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General NPI Number Information
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NPI Number | 1497796700
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Entity Type | Individual
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Provider Name | MAUREEN A LILLICH M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 1001 W MAIN ST SUITE 500A
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City | PEORIA
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State | IL
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Zip | 61606-1276
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Country | US
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Telephone | 309-672-4980
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Fax | 309-671-2944
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | MORTON
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State | IL
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Zip | 61550-0365
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Country | US
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Telephone | 309-672-4980
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Fax | 309-691-2944
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036084518
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License Number State | IL
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