Tillery, Jeffry Mark

Tillery, Jeffry Mark is an individual health care provider with primary practice located at 9951 Rock Cut Xing , Loves Park IL 61111-1999. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Tillery, Jeffry Mark can be contacted via phone (815) 639-8500.

Contact Information

Primary practice address
9951 Rock Cut Xing Loves Park IL 61111-1999
Phone: (815) 639-8500
Fax: (815) 639-8501
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036078730 Illinois

Profile Details

NPI number 1689602211
LBN Legal business name Tillery, Jeffry Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2006
Last updated Apr 6th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689602211 NPPES
Illinois MEDICAID 036078730
Illinois Other 553180

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