Provider Demographics
NPI:1932144326
Name:TSENG, LILI AMY (MD)
Entity Type:Individual
Prefix:DR
First Name:LILI
Middle Name:AMY
Last Name:TSENG
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 1:1310 DADRIAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1685
Mailing Address - Country:US
Mailing Address - Phone:618-433-5005
Mailing Address - Fax:618-467-1053
Practice Address - Street 1:1310 DADRIAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1685
Practice Address - Country:US
Practice Address - Phone:618-433-5005
Practice Address - Fax:618-467-1053
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115892207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00348104OtherMEDICARE RR
ILI38788Medicare UPIN
IL0553590001Medicare NSC
K28363Medicare PIN