Provider Demographics
NPI:1457095192
Name:BILODEAU, CONNOR J
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:J
Last Name:BILODEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CANDLEWYCK DR APT 906
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5485
Mailing Address - Country:US
Mailing Address - Phone:517-882-3583
Mailing Address - Fax:
Practice Address - Street 1:112 CANDLEWYCK DR APT 906
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-5485
Practice Address - Country:US
Practice Address - Phone:517-882-3583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator