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General NPI Number Information
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NPI Number | 1629408091
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Entity Type | Individual
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Provider Name | ANTHONY JOHN CILLUFFO MS, AT, ATC, CEIS
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Gender | Male
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 2200 DENDRINOS DR STE 102
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-8895
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Country | US
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Telephone | 616-331-5700
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Fax | 616-331-5999
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Provider Business Mailing Address
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Address Line | 1 CAMPUS DR 2015 JAMES H. ZUMBERGE HALL
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City | ALLENDALE
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State | MI
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Zip | 49401-9403
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Country | US
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Telephone | 616-331-5700
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Fax | 616-331-5999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001019
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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