Provider Demographics
NPI:1366639213
Name:CID, LILIA MARCELINA (MD)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:MARCELINA
Last Name:CID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:114 NE 3RD ST
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0699
Mailing Address - Country:US
Mailing Address - Phone:701-477-3111
Mailing Address - Fax:701-477-6342
Practice Address - Street 1:114 3RD ST NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-7137
Practice Address - Country:US
Practice Address - Phone:701-477-3111
Practice Address - Fax:701-477-6342
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND10591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14424Medicaid