Provider Demographics
NPI:1194965459
Name:BILJANIC, TRISHA (PA)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:BILJANIC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5446 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:317-472-7317
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-802-3146
Practice Address - Fax:317-870-0499
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001063A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400032092Medicare PIN