MEDICARE: KATHLEEN M BILAK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1586	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1022820	OTHER	AZ	NCCPA CERTIFICATE

General Provider Information

NPI Number	:	1215052345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M BILAK PA-C

Provider Business Mailing Address
First Line	:	300 W CLARENDON AVE STE 350
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3497
Country	:	US
Telephone Number	:	602-274-4484
Fax Number	:	602-287-9406

Provider Business Practice Location Address
First Line	:	6525 W SACK DR STE 105
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7106
Country	:	US
Telephone Number	:	602-274-4484
Fax Number	:	602-287-9406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	04/06/2011

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Directions to “ KATHLEEN M BILAK PA-C” Practice Location

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