Basic Information
| Provider Information | |||||||||
| NPI: | 1295303295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEROUT | ||||||||
| FirstName: | LILY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18675 W EDWARDS RD | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600027231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473238344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128661090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185873222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2021 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.