DR. POLLY A LILLEBOE (NPI# 1225182454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225182454 |
| Entity Type | Individual |
| Full Name | DR. POLLY A LILLEBOE |
| Credential | MD |
| Practice Address |
805 Oakland Street St Johns MI 48879 |
| Mailing Address |
1500 S Main St Eaton Rapids MI 48827-1952 |
| Practice Telephone | 9892273400 |
| Mailing Telephone | 5176639555 |
| Mailing Fax Number | 5176633430 |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-02-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 4301047563 | MI | Other Service Providers |
| Y | 207P00000X | Emergency Medicine | 430104756 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | TAX ID | 382168683 | 01 |
| MI | 1728309 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1500 S Main St, Eaton Rapids, MI 488271952 | 5176639555 | 5176633430 |
| Street Address |
805 OAKLAND STREET |
| City | ST JOHNS |
| State | MI |
| Zip Code | 48879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003383035 | Soledad Poquiz | Physical Therapist | 1011 Old U.S. 27 Suite A, St. Johns, MI 48879 | 2018-10-29 |
| 1134613680 | Edward Peters Iv | Optometrist | 1002 Old U.S. 27, St. Johns, MI 48879 | 2018-06-19 |
| 1386082352 | Jennie Louise Findlay | Physical Therapist | 6798 Findlay Road, Saint Johns, MI 48879 | 2013-06-11 |
| 1528200839 | Heidi Jo Glew | Social Worker | 6190 W. Centerline Rd, St. Johns, MI 48879 | 2009-04-01 |
| 1376721084 | Richard Heaton | Registered Nurse | 701 Mortin St, St Johns, MI 48879 | 2008-02-05 |
| 1992830038 | Rodger Wesley Massa | Chiropractor | 1004 N Us 27, St Johns, MI 48879 | 2007-02-22 |
| 1730272485 | St. Johns Counseling and Therapy Services, P.C. | Social Worker | 1505 Waterford Parkway, St. Johns, MI 48879 | 2006-10-02 |
| 1093810400 | Janet Lynn Woodcock | Social Worker | 120 E Walker Street, St Johns Counseling & Therapy Services PC Suite B, St Johns, MI 48879 | 2006-09-13 |
| 1366481194 | Beth Ann Snyder-petrowitz | Nurse Anesthetist, Certified Registered | 805 S. Oakland, St. John's, MI 48879 | 2006-06-06 |
| 1225528441 | Travis Brian Scott | Nurse Practitioner | 110 W Higham St, Saint Johns, MI 48879 | 2018-05-14 |
| Find all providers in zip 48879 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386265452 | Kyle Patrick Doran | Emergency Medicine | Sparrow Health System, 1215 E Michigan Avenue, Lansing, MI 48912 | 2020-04-30 |
| 1750901658 | Annika Van Wieren | Emergency Medicine | 22101 Moross Road, Emergency Department, Detroit, MI 48236 | 2020-04-21 |
| 1245850171 | Dema Fawaz | Emergency Medicine | Beaumont Hospital, Royal Oak, Gme Office, 3601 W. 13 Mile Rd, Royal Oak, MI 48073 | 2020-04-21 |
| 1568002004 | Munson Medical Center | Emergency Medicine | 5085 Anna Dr Ste B&c, Traverse City, MI 49684-7475 | 2020-01-13 |
| 1366002735 | Mansour Mansour | Emergency Medicine | 4965 Heather Dr Apt 107, Dearborn, MI 48126-2862 | 2019-06-18 |
| 1376101949 | David G Morrison IIi | Emergency Medicine | 1815 Dallas Ave, Royal Oak, MI 48067-3577 | 2019-05-30 |
| 1851852263 | Samantha Allegra Chamberlain | Emergency Medicine | 22101 Moross Rd., Emergency Department, Detroit, MI 48236-2148 | 2019-03-28 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1598226029 | Alicia Paulette Flores | Emergency Medicine | Henry Ford Wyandotte Hosptial, Medical Education, 2333 Biddle Ave, Wyandotte, MI 48192 | 2019-03-27 |
| 1417417536 | Joseph Julius Vermeulen | Emergency Medicine | 2799 W Grand Blvd, Cfp 258, Detroit, MI 48202-2689 | 2019-03-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.