ZACHARIAS, AMY (MD)

Provider Demographics

• NPI: 1295754984
• Name: ZACHARIAS, AMY (MD)
• Entity type: Individual
• Prefix: DR
• First Name: AMY
• Last Name: ZACHARIAS
• Gender: F
• Credentials: MD
• Mailing Address - Street 1: 448 WYLIE DR
• Mailing Address - City: NORMAL
• Mailing Address - State: IL
• Mailing Address - Zip Code: 61761-5405
• Mailing Address - Country: US
• Mailing Address - Phone: 888-924-3786
• Mailing Address - Fax: 309-268-3649
• Practice Address - Street 1: 702 W CHESTNUT ST
• Practice Address - City: BLOOMINGTON
• Practice Address - State: IL
• Practice Address - Zip Code: 61701-2814
• Practice Address - Country: US
• Practice Address - Phone: 309-557-1400
• Is Sole Proprietor?: No
• Enumeration Date: 2006-07-19
• Last Update Date: 2023-10-27

Provider Licenses

State	License ID	Taxonomies
IL	036109906	207Q00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	10215111	Other	BLUE CROSS BLUE SHIELD
IL	036109906	Medicaid
IL	200871	Medicare ID - Type Unspecified	MEDICARE GROUP INT
IL	K30279	Medicare ID - Type Unspecified	MEDICARE PIN FMA
IL	K30283	Medicare ID - Type Unspecified	MEDICARE PIN INT
IL	K30285	Medicare ID - Type Unspecified	MEDICARE PIN EP
IL	K30280	Medicare ID - Type Unspecified	MEDICARE PIN HPT
IL	712180	Medicare ID - Type Unspecified	MEDICARE GROUP TCH
IL	748940	Medicare ID - Type Unspecified	MEDICARE GROUP HPT
IL	748942	Medicare ID - Type Unspecified	MEDICARE GROUP LEX
IL	K30286	Medicare ID - Type Unspecified	MEDICARE PIN LEX
IL	K30284	Medicare ID - Type Unspecified	MEDICARE PIN LFM
	K05836	Medicare ID - Type Unspecified
	H99462	Medicare UPIN
IL	208829	Medicare ID - Type Unspecified	MEDICARE GROUP FMA
IL	748943	Medicare ID - Type Unspecified	MEDICARE GROUP EP
	10215111	Other	BLUE CROSS BLUE SHIELD
IL	K30281	Medicare ID - Type Unspecified	MEDICARE PIN SCM