Provider Demographics
NPI:1447200803
Name:BILELLA, MARK ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:BILELLA
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 1:10111 WILSKY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625
Mailing Address - Country:US
Mailing Address - Phone:813-961-2222
Mailing Address - Fax:813-961-2220
Practice Address - Street 1:10111 WILSKY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-961-2222
Practice Address - Fax:813-961-2220
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87304207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2107756OtherFIRST HEALTH
FL916502OtherUSA
FL1000150OtherCITRUS HEALTHCARE
FL1891OtherBAYCARE
FL360122OtherAETNA-ADULT
FL456279OtherAETNA-PEDIATRICS
FL81240OtherBLUE CROSS/BLUE SHIELD
FL188455OtherAMERIGROUP
FL06599OtherUNIVERSAL HEALTH CARE
FL267054200Medicaid
FL7158408OtherCIGNA
FL224474OtherWELLCARE
FL290716OtherAVMED
FLH92741Medicare UPIN
FL06599OtherUNIVERSAL HEALTH CARE
FL1891OtherBAYCARE