Doctor Name: | KEITH D LILLEMOE |
NPI Number: | 1215982467 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 1058276A |
Business Practice Address: | 545 Barnhill Dr Em 523 Indianapolis, IN - 462025112 |
Business Phone Number: | 3172743086 |
Business Fax Number: | 3172781886 |
Mailing Address: | 545 Barnhill Dr, Em 523 INDIANAPOLIS |
State: | IN |
Postal Code: | 462025112 |
Phone Number: | 3172743086 |
Fax Number: | 3172781886 |
NPI Enumeration Date: | 05/24/2006 |
NPI Last Update Date: | 06/16/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 1058276A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |