Provider Demographics
NPI:1871555466
Name:LILL, SUSAN R (DO)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:LILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:15325 W. 95TH ST.
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219
Mailing Address - Country:US
Mailing Address - Phone:913-310-9711
Mailing Address - Fax:913-310-9714
Practice Address - Street 1:15325 W. 95TH ST.
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219
Practice Address - Country:US
Practice Address - Phone:913-310-9711
Practice Address - Fax:913-310-9714
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50739Medicare UPIN