Provider Demographics
NPI:1144313743
Name:INTERNAL MEDICINE ASSOCIATES INC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LILLESTOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-280-2033
Mailing Address - Street 1:4450 31ST AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4557
Mailing Address - Country:US
Mailing Address - Phone:701-280-2033
Mailing Address - Fax:701-232-5578
Practice Address - Street 1:4450 31ST AVE S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4557
Practice Address - Country:US
Practice Address - Phone:701-280-2033
Practice Address - Fax:701-232-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN162D7INOtherMN BLUE SHIELD
MN301713300Medicaid
ND11941Medicaid
ND05595001OtherND BLUE SHIELD
ND=========OtherCOMMERCIAL
NDN71132Medicare ID - Type Unspecified
ND=========OtherCOMMERCIAL