Doctor Name: | DR. THEODORE J LILLEHEI |
NPI Number: | 1619941499 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 29143 |
Business Practice Address: | 280 Smith Ave N Ste 311 Saint Paul, MN - 551022465 |
Business Phone Number: | 6513303656 |
Business Fax Number: | 6513401160 |
Mailing Address: | 280 Smith Ave N, Suite 311 SAINT PAUL |
State: | MN |
Postal Code: | 551022424 |
Phone Number: | 6513303656 |
Fax Number: | 6513401160 |
NPI Enumeration Date: | 02/16/2006 |
NPI Last Update Date: | 02/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 29143 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
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. |