Provider Demographics
NPI:1801849161
Name:PELLEGRINI, LISA C (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:PELLEGRINI
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 1:1250 N MILL ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-6304
Mailing Address - Country:US
Mailing Address - Phone:630-646-8000
Mailing Address - Fax:630-646-8007
Practice Address - Street 1:1250 N MILL ST
Practice Address - Street 2:STE 100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6304
Practice Address - Country:US
Practice Address - Phone:630-646-8000
Practice Address - Fax:630-646-8007
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360999582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099958 2Medicaid
IL2220936OtherBCBS
IL2220936OtherBCBS
G99105Medicare UPIN
ILK27966Medicare PIN