Provider Demographics
NPI:1063513604
Name:BILLOW, DAKANE A (MD)
Entity type:Individual
Prefix:
First Name:DAKANE
Middle Name:A
Last Name:BILLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVENUE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-537-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96256207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2690818OtherUNITED
CAMCMG487600OtherWESTERN HEALTH ADVANTAGE
CA5716504OtherFIRST HEALTH
CA00A962560OtherBLUE SHIELD
CA2091310OtherGREAT WEST
CA2440269OtherCIGNA
CAA96256OtherBLUE CROSS
CA000810816167OtherPHCS
CA00A962560Medicaid
CA90205607OtherPACIFICARE
CA7700878OtherAETNA
CA132691OtherHEALTH NET
CA457412OtherINTERPLAN
CA5716504OtherFIRST HEALTH
CA00A962560Medicare ID - Type Unspecified