Provider Demographics
NPI:1407872500
Name:BILOTTA, ANTHONY LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LOUIS
Last Name:BILOTTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PLAINFIELD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7607
Mailing Address - Country:US
Mailing Address - Phone:630-986-7501
Mailing Address - Fax:
Practice Address - Street 1:535 PLAINFIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7607
Practice Address - Country:US
Practice Address - Phone:630-986-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3350207Q00000X
WI42827-021207Q00000X
MN43369207Q00000X
IL036-073808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00401037OtherMEDICARE RAILROAD
MN554113100Medicaid
IL02232966OtherBCBSIL
WI43490800Medicaid
ILK40062Medicare PIN
MN554113100Medicaid