Provider Demographics
NPI:1851553861
Name:BILIACK, CHRISTINA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LYNN
Last Name:BILIACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:ATTN: JEANA SCOTT, CREDENTIALING
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-6922
Mailing Address - Fax:
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD
Practice Address - Street 2:ATTN: JEANA SCOTT, CREDENTIALING
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-876-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR941207R00000X
AZ005197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139547Medicare PIN
Z130960Medicare PIN