Provider Demographics
NPI:1396946125
Name:BERCK, LILLA GYIRES (MD)
Entity type:Individual
Prefix:DR
First Name:LILLA
Middle Name:GYIRES
Last Name:BERCK
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 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3981
Mailing Address - Country:US
Mailing Address - Phone:309-663-8311
Mailing Address - Fax:
Practice Address - Street 1:1401 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3552
Practice Address - Country:US
Practice Address - Phone:309-663-3111
Practice Address - Fax:309-661-3390
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36118519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118519Medicaid
IL5715384OtherBLUE CROSS BLUE SHIELD
ILK40155Medicare PIN