Provider Demographics
NPI:1720799273
Name:LITHGOW, DAVID GLENN
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GLENN
Last Name:LITHGOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-1413
Mailing Address - Country:US
Mailing Address - Phone:217-781-3162
Mailing Address - Fax:
Practice Address - Street 1:1500 N 5TH ST STE 203
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2643
Practice Address - Country:US
Practice Address - Phone:217-284-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2003239251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based