Active NPI
Wade Alan Lillegard
- Sports Medicine (Family Medicine) Physician
- Duluth, MN
National Provider Identifier
1497790547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 38439
- Practice address
- 400 E 3Rd St
Duluth, MN 55805-1951 - Phone
- (218) 786-8364
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 38439 | MN | Primary |
Addresses
Primary practice location
400 E 3Rd St
Duluth, MN 55805-1951
Mailing address
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 326019400 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304899200000",
"number": "1497790547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E 3RD ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-786-8364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E 3RD ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-786-8364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLEGARD",
"first_name": "WADE",
"middle_name": "ALAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2011-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "MN",
"license": "38439",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "326019400",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.