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General NPI Number Information
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NPI Number | 1316034432
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Entity Type | Individual
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Provider Name | LYNETTE GILLIS MD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 411 E CHESTNUT ST STE 5B
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City | LOUISVILLE
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State | KY
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Zip | 40202-1713
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Country | US
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Telephone | 502-588-2330
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Fax | 502-588-9513
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-588-9490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | MD38932
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 57884
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License Number State | KY
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