Provider Demographics
NPI:1285625749
Name:LILLARD, STEPHEN B (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:LILLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E CHERRY ST
Mailing Address - Street 2:ATTN: 3RD FLOOR PULMONARY CLINIC
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1513
Mailing Address - Country:US
Mailing Address - Phone:636-528-3321
Mailing Address - Fax:636-528-3212
Practice Address - Street 1:1000 E CHERRY ST
Practice Address - Street 2:ATTN: 3RD FLOOR PULMONARY CLINIC
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1513
Practice Address - Country:US
Practice Address - Phone:636-528-3321
Practice Address - Fax:636-528-3212
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80126-21207RP1001X
MOMO32884207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1285625749Medicaid
CE7661OtherMEDICARE RAILROAD
MO241895705Medicaid
P00060884OtherMEDICARE RR INDIV
MO009010417Medicare PIN
CE7661OtherMEDICARE RAILROAD
MO241895705Medicaid
MO010010902Medicare PIN