Basic Information
| Provider Information | |||||||||
| NPI: | 1093756520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BILLAK | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43736 CAMERON RD | ||||||||
| Address2: | |||||||||
| City: | WELLSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439689734 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1995 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444602423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303321551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34003457 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 942460636204 | 01 | OH | CARESOURCE | OTHER | P00220583 | 01 | OH | MEDICARE RR-GA | OTHER |