Provider Demographics
NPI:1144994823
Name:LILLY PODIATRY
Entity type:Organization
Organization Name:LILLY PODIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUKHANA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-331-6527
Mailing Address - Street 1:1479 N MILWAUKEE AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1342
Mailing Address - Country:US
Mailing Address - Phone:847-331-6527
Mailing Address - Fax:
Practice Address - Street 1:1479 N MILWAUKEE AVE APT 114
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1342
Practice Address - Country:US
Practice Address - Phone:847-331-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LILLY PODIATRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Multi-Specialty