Provider Demographics
NPI:1902808983
Name:LILKO, MARY MARGARET (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:LILKO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:NIPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:941-202-5342
Practice Address - Street 1:4451 AIDAN LN STE 201
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-4934
Practice Address - Country:US
Practice Address - Phone:941-423-1111
Practice Address - Fax:941-423-2274
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGU4195397OtherMEDICARE PTAN
OH2265909Medicaid
OHH41722Medicare UPIN
OH2265909Medicaid