Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 258 | NC |
Y | 222Z00000X | Podiatrist | 258 | NC |
NPI | 1003860990 |
---|---|
Provider Name | Steven Joseph Tilles |
First Address | High Point, NC 27262-7254 |
Second Address | High Point, NC 27262-4820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 06/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1212660025 | DME (01) | NC |
480031936 | RR MEDICARE (01) | NC |
890803V | (05) | NC |
890816C | (05) | NC |
T64109 | (02) |