Provider Demographics
NPI:1114913944
Name:ZILLMER, DEBRA ANN (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:ZILLMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FIRST STREET, SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905
Mailing Address - Country:US
Mailing Address - Phone:507-284-2947
Mailing Address - Fax:507-266-4234
Practice Address - Street 1:200 FIRST STREET, SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905
Practice Address - Country:US
Practice Address - Phone:507-284-2947
Practice Address - Fax:507-266-4234
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104352207X00000X, 207XX0005X
MN34112207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00948581OtherRAILROAD MEDICARE
IL036104352Medicaid
MNENROLLEDMedicaid
IL200042818OtherRAILROAD MEDICARE
MN200002987Medicare PIN
MNENROLLEDMedicaid
MNP00948581OtherRAILROAD MEDICARE
ILL88487Medicare PIN
IL0371240002Medicare NSC