Provider Demographics
NPI:1154300556
Name:BILANT, KEVIN (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BILANT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 TYLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4361
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:440-777-6940
Practice Address - Street 1:8808 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4361
Practice Address - Country:US
Practice Address - Phone:440-255-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003298213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2339044Medicaid
OHU92714Medicare UPIN
OH4096481Medicare PIN