Provider Demographics
NPI:1104108695
Name:LILLESTOL RESEARCH LLC
Entity type:Organization
Organization Name:LILLESTOL RESEARCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LILLESTOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-232-7705
Mailing Address - Street 1:1711 GOLD DR S
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6416
Mailing Address - Country:US
Mailing Address - Phone:701-232-7705
Mailing Address - Fax:701-893-9046
Practice Address - Street 1:1711 GOLD DR S
Practice Address - Street 2:SUITE 170
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6416
Practice Address - Country:US
Practice Address - Phone:701-232-7705
Practice Address - Fax:701-893-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30611363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty