Provider Demographics
NPI:1528014396
Name:BILBY, JANICE L (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:BILBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E COUNTY LINE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1072
Mailing Address - Country:US
Mailing Address - Phone:317-882-0535
Mailing Address - Fax:317-882-0173
Practice Address - Street 1:701 E COUNTY LINE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1072
Practice Address - Country:US
Practice Address - Phone:317-882-0535
Practice Address - Fax:317-882-0173
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032228A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100074050Medicaid
IN000000312875OtherANTHEM
IN214480AMedicare PIN
INM400045987Medicare PIN
INP0071874Medicare PIN
INB28486Medicare UPIN
INM400046000Medicare PIN