Provider Demographics
NPI:1568490977
Name:DILLA, ANN MARIE (DO)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:DILLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2507 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5407
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:815-759-4078
Practice Address - Street 1:2507 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:815-759-4078
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-085669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085669OtherSTATE LICENSE
ILE33581Medicare UPIN