Provider Demographics
NPI:1730132531
Name:BILOTTA, JEFFREY J (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:BILOTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3903 SOUTH 7TH STREET
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-323-5900
Mailing Address - Fax:812-232-2370
Practice Address - Street 1:3903 S 7TH ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5710
Practice Address - Country:US
Practice Address - Phone:812-323-5900
Practice Address - Fax:812-232-2370
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037430A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100252180AMedicaid
IN100252180AMedicaid
IN608580AMedicare PIN