Individual
AJA LYSTILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2512 HURST DR., FAMILY MEDICINE, MATTOON, IL 61938-9388
(217) 258-5900
(217) 258-5904
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
(217) 258-5904
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036119163
IL
207Q00000X
Family Medicine Physician
Primary
036119163
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036119163
—
IL
Enumeration date
05/03/2007
Last updated
03/09/2015
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