Provider Demographics
NPI:1558369231
Name:PILLSBURY, LISA L (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:PILLSBURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120W 22ND ST 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-974-5240
Mailing Address - Fax:630-974-5274
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-952-9332
Practice Address - Fax:847-952-9338
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084900207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616108OtherBCBS
IL036084900Medicaid
ILL84439Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
IL036084900Medicaid
IL110106223Medicare PIN
ILF33769Medicare UPIN
ILC30486Medicare PIN
IL1616108OtherBCBS
IL575480Medicare ID - Type UnspecifiedGROUP NUMBER