Basic Information
| Provider Information | |||||||||
| NPI: | 1235344433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LILLIG | ||||||||
| FirstName: | MATHIAS | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1358 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672011358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162933429 | ||||||||
| FaxNumber: | 8554953229 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N MINNEAPOLIS ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162932647 | ||||||||
| FaxNumber: | 8554760305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 10/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 04-37527 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.