Provider Demographics
NPI:1477532703
Name:DILLMAN, D. GENE II (MD)
Entity Type:Individual
Prefix:DR
First Name:D.
Middle Name:GENE
Last Name:DILLMAN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 NICHOLASVILLE RD
Mailing Address - Street 2:UNIT 404
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1429
Mailing Address - Country:US
Mailing Address - Phone:859-255-7918
Mailing Address - Fax:859-254-0515
Practice Address - Street 1:1517 NICHOLASVILLE RD
Practice Address - Street 2:UNIT 404
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1429
Practice Address - Country:US
Practice Address - Phone:859-255-7918
Practice Address - Fax:859-254-0515
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64297633Medicaid
KY80167885Medicare PIN
KY64297633Medicaid
F73283Medicare UPIN