Provider Demographics
NPI:1629408091
Name:CILLUFFO, ANTHONY JOHN (MS, AT, ATC, CEIS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:CILLUFFO
Suffix:
Gender:M
Credentials:MS, AT, ATC, CEIS
Other - Prefix:
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Mailing Address - Street 1:1 CAMPUS DR
Mailing Address - Street 2:2015 JAMES H. ZUMBERGE HALL
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9403
Mailing Address - Country:US
Mailing Address - Phone:616-331-5700
Mailing Address - Fax:616-331-5999
Practice Address - Street 1:2200 DENDRINOS DR
Practice Address - Street 2:STE 102
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8895
Practice Address - Country:US
Practice Address - Phone:616-331-5700
Practice Address - Fax:616-331-5999
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2025-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI26010010192255A2300X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer