Provider Demographics
NPI:1497796700
Name:LILLICH, MAUREEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:LILLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-0365
Mailing Address - Country:US
Mailing Address - Phone:309-672-4980
Mailing Address - Fax:309-691-2944
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:SUITE 500A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1276
Practice Address - Country:US
Practice Address - Phone:309-672-4980
Practice Address - Fax:309-671-2944
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084518207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL008852OtherHEALTH ALLIANCE
IL036084518Medicaid
IL4282558OtherAETNA HEALTH PLANS
IL110068683OtherRAILROAD MEDICARE
ILIL0106OtherJOHN DEERE
IL180607OtherHEALTHLINK
IL07215152OtherBLUE CROSS
IL371221637OtherFEDERAL TAX IDENTIFICATIO
IL776530OtherMEDICARE GROUP NUMBER
IL110068683OtherRAILROAD MEDICARE
IL036084518Medicaid