Provider Demographics
NPI:1407845613
Name:BILNOSKI, DANA L (DO)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:BILNOSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:L
Other - Last Name:NITKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:500 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2773
Mailing Address - Country:US
Mailing Address - Phone:561-626-6695
Mailing Address - Fax:561-626-6628
Practice Address - Street 1:500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE #208
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2773
Practice Address - Country:US
Practice Address - Phone:561-626-6695
Practice Address - Fax:561-626-6628
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3402207Q00000X
FLOS 8654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08WCHTQ-Z75993Medicare ID - Type Unspecified
G96420Medicare UPIN