Provider Demographics
NPI:1346291721
Name:BILLITER, DENNIS ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROSS
Last Name:BILLITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SAINT FRANCIS WAY
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1779
Mailing Address - Country:US
Mailing Address - Phone:217-324-4200
Mailing Address - Fax:217-324-8786
Practice Address - Street 1:805 SAINT FRANCIS WAY
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1779
Practice Address - Country:US
Practice Address - Phone:217-324-4200
Practice Address - Fax:217-324-8786
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040410208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020035220OtherRAILROAD MEDICARE
IL036040410Medicaid
020035220OtherRAILROAD MEDICARE
IL779330Medicare ID - Type UnspecifiedGROUP PROVIDER #
IL143822Medicare ID - Type UnspecifiedMEDICARE RHC
IL143822Medicare Oscar/Certification