Lillegard, Wade Alan

Lillegard, Wade Alan is an individual health care provider with primary practice located at 400 E 3Rd St , Duluth MN 55805-1951. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Lillegard, Wade Alan can be contacted via phone (218) 786-8364.

Contact Information

Primary practice address
400 E 3Rd St Duluth MN 55805-1951
Phone: (218) 786-8364
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 38439 Minnesota

Profile Details

NPI number 1497790547
LBN Legal business name Lillegard, Wade Alan
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2006
Last updated May 9th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497790547 NPPES
Minnesota MEDICAID 326019400

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