Lilly Aesthetics SC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

LILLY AESTHETICS SC

Practice address

2500 S Highland Ave Ste 220
Lombard, IL 60148-7103

Phone

(630) 317-7338

NPI assigned

Dec 23, 2019

Last updated

Dec 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mercy Odueyungbo, MD

Title

President

Phone

(630) 317-7338

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1577059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577059200000",
    "number": "1295374270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 644",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498550644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 S HIGHLAND AVE STE 220",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601487103",
            "telephone_number": "630-317-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILLY AESTHETICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-23",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A",
        "authorized_official_last_name": "ODUEYUNGBO",
        "authorized_official_first_name": "MERCY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-317-7338",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Chao Lichon, M.D.
• Frances Ann Aquino Licup
• Lifespace Communities Inc (Lifespace Personal Services)
• Lifespace Communities Inc (Beacon Hill)
• Erica Ligons
• Liluke Enterprises LLC (MI Lab)
• Jennifer L Lim, PA-C
• Hemlata S. Limaye, M.D.
• Limra Medical Associates Group SC
• Hubert Lin, FNP-C, APN

• MOHS-Micrographic Surgery Physician in Lombard, IL
• Providers in Lombard, IL by specialty
• MOHS-Micrographic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.