Provider Demographics
NPI:1487040929
Name:DIBIASE, JILLIAN ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:ANNE
Last Name:DIBIASE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-5170
Mailing Address - Fax:312-227-9730
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-5170
Practice Address - Fax:312-227-9730
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.152344207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology