Provider Demographics
NPI:1114028107
Name:ZILLS, LYNETTE Y (MD)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:Y
Last Name:ZILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:Y
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7191 CAHABA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6443
Mailing Address - Country:US
Mailing Address - Phone:205-408-2365
Mailing Address - Fax:
Practice Address - Street 1:1025 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2403
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086942207Q00000X
ALMD.35499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086942Medicaid
F61470Medicare UPIN
F61470Medicare UPIN