Provider Demographics
NPI:1285653766
Name:LILLEHEI, CRAIG W (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:LILLEHEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16 CRAFTSLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2632
Mailing Address - Country:US
Mailing Address - Phone:617-277-0753
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FEGAN 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-3039
Practice Address - Fax:617-730-0298
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46255204F00000X, 208600000X, 2086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
B74176Medicare UPIN