Provider Demographics
NPI:1003860990
Name:TILLES, STEVEN JOSEPH (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:TILLES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:1814 WESTCHESTER DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4820
Practice Address - Country:US
Practice Address - Phone:336-802-2055
Practice Address - Fax:336-802-2056
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC258213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890816CMedicaid
NC480031936OtherRR MEDICARE
NC890803VMedicaid
NC1212660025OtherDME
NC1212660025OtherDME
NC890803VMedicaid