Provider Demographics
NPI:1912005232
Name:SILLINS, DEBORAH R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:R
Last Name:SILLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3005 DIXIE HWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2352
Mailing Address - Country:US
Mailing Address - Phone:859-341-3309
Mailing Address - Fax:859-578-4642
Practice Address - Street 1:3005 DIXIE HWY
Practice Address - Street 2:SUITE 240
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2352
Practice Address - Country:US
Practice Address - Phone:859-341-3309
Practice Address - Fax:859-578-4642
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY28900208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64289002Medicaid
KYF65942Medicare UPIN
KY64289002Medicaid