Provider Demographics
NPI:1225213432
Name:LILLIS, JOSEPH VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:LILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E. HARMONY RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3402
Mailing Address - Country:US
Mailing Address - Phone:970-305-4341
Mailing Address - Fax:970-482-9948
Practice Address - Street 1:3609 S TIMBERLINE RD UNIT A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3430
Practice Address - Country:US
Practice Address - Phone:970-305-4341
Practice Address - Fax:970-482-9948
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL16967207N00000X
CAA109366207N00000X
CO47867207NS0135X
CODR.0047867207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology