Individual
MRS. AMY L ILLESCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10 MEADOWVIEW DR, HOOVER, AL 35242-7700
(205) 547-2323
(205) 995-0955
Mailing address
10 MEADOWVIEW DR, HOOVER, AL 35242-7700
(205) 547-2323
(205) 995-0955
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23912
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051540201
ALABAMA MEDICARE PTAN#
AL
01
—
515-94994
BCBS#
AL
Enumeration date
07/19/2006
Last updated
10/06/2023
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