Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036127284 | IL |
N | 207QS0010X | Family Doctor - Sports Medicine | 036127284 | IL |
NPI | 1053516971 |
---|---|
Provider Name | Scott M Bilyeu |
First Address | Decatur, IL 62526-4392 |
Second Address | Decatur, IL 62521-5139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 29/12/2021 |