Provider Demographics
NPI:1225027204
Name:WILLS, CYNTHIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:WILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:KIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1416
Mailing Address - Country:US
Mailing Address - Phone:317-745-7759
Mailing Address - Fax:317-745-0825
Practice Address - Street 1:202 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1416
Practice Address - Country:US
Practice Address - Phone:317-745-7759
Practice Address - Fax:317-745-0825
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033836A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100133680AMedicaid
IN253030AMedicare PIN
IN100133680AMedicaid