Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DL13013 | MA |
Y | 1223P0300X | Periodontist | 136000247 | IL |
N | 1223P0300X | Periodontist | DL13013 | MA |
NPI | 1144775149 |
---|---|
Provider Name | Dr. Sunny K Tilwani |
First Address | Chicago, IL 60661-2547 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2016 |
Last Update Date | 14/05/2019 |