Derek James Lillestolen, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OT022767 Issued in PA

Practice address

1200 S Cedar Crest Blvd
Allentown, PA 18103-6202

Phone

(484) 862-3200

NPI assigned

Jun 20, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1245915917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 LEHIGH PKWY E APT 414",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181033061",
            "telephone_number": "860-392-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S CEDAR CREST BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036202",
            "telephone_number": "484-862-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLESTOLEN",
        "first_name": "DEREK",
        "middle_name": "JAMES",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OT022767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard M Lieberman, MD
• Jessica E Lievendag, MA, LPC,
• Lifted Lotus Wellness
• Cephria Solomom Ligon, PHYSICAL THERAPIST
• Ambria Liles, MS
• Tori Irene Lillestolen, DO
• Jennifer Lilley, LPC
• Brad H Lilly, DPM
• Marigrace Lim, M.D.
• Edla Lima, MD

• Internal Medicine Physician in Allentown, PA
• Providers in Allentown, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.