Tillman, Wayne A

Tillman, Wayne A is an sole proprietor health care provider with primary practice located at 13011 S. 104Th Ave. Suite 201, Palos Park IL 60464-1512. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Tillman, Wayne A can be contacted via phone (708) 923-0400.

Contact Information

Primary practice address
13011 S. 104Th Ave. Suite 201 Palos Park IL 60464-1512
Phone: (708) 923-0400
Fax: (708) 923-0600
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 016004926 Illinois

Profile Details

NPI number 1174698138
LBN Legal business name Tillman, Wayne A
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 22nd, 2006
Last updated Nov 1st, 2013 - about 12 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 1174698138 NPPES
Illinois Other 2700614 UHC
Illinois Other 1626136 UHC
Illinois Other 4861340001 UHC
Illinois Other 480034104 UHC

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