Provider Demographics
NPI:1023231289
Name:WILLOWBROOK MEDICAL CENTER LTD.
Entity type:Organization
Organization Name:WILLOWBROOK MEDICAL CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BILOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-986-7501
Mailing Address - Street 1:535 PLAINFIELD ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-986-7501
Mailing Address - Fax:630-986-7505
Practice Address - Street 1:535 PLAINFIELD ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-986-7501
Practice Address - Fax:630-986-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078620173000000X, 202C00000X, 207Q00000X, 208000000X, 2083P0901X, 2083X0100X, 261QP2000X, 261QU0200X
IL036073808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
C34238Medicare UPIN
ILK31292Medicare ID - Type UnspecifiedBILOTTA
E24558Medicare UPIN
ILK31293Medicare ID - Type UnspecifiedGROSS