MEDICARE: DR. EVILLO M DOMINGO 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	35-07-4369-D	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	:	1770587693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVILLO M DOMINGO MD

Provider Business Mailing Address
First Line	:	2405 BIG WOODS DR
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-7650
Country	:	US
Telephone Number	:	567-224-0854
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 BIG WOODS DR
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-7650
Country	:	US
Telephone Number	:	630-277-9651
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/10/2025

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