Provider Demographics
NPI:1124207931
Name:HILL, EMILIYA S (MD)
Entity type:Individual
Prefix:
First Name:EMILIYA
Middle Name:S
Last Name:HILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 BROADWAY
Mailing Address - Street 2:SUITES A-C
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8148
Mailing Address - Country:US
Mailing Address - Phone:239-274-3004
Mailing Address - Fax:239-274-6007
Practice Address - Street 1:3822 BROADWAY
Practice Address - Street 2:SUITES A-C
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8148
Practice Address - Country:US
Practice Address - Phone:239-274-3004
Practice Address - Fax:239-274-6007
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL10244207Q00000X
FLME105043208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12083Medicaid
NDN6252Medicare PIN