MEDICARE: MARK ANDREW HILLYER MD

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	207Q00000X	Family Medicine Physician	35082430	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649248840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANDREW HILLYER MD

Provider Business Mailing Address
First Line	:	6046 WHIPPLE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7616
Country	:	US
Telephone Number	:	330-874-7165
Fax Number	:	330-874-7166

Provider Business Practice Location Address
First Line	:	10724 STATE ROUTE 212 NE
Second Line	:
City	:	BOLIVAR
State	:	OH
Zip	:	44612-8740
Country	:	US
Telephone Number	:	330-874-7165
Fax Number	:	330-874-7166

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	02/17/2012

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