Provider Demographics
NPI:1033482351
Name:STEVEN M. TILLES, M.D., INC.
Entity Type:Organization
Organization Name:STEVEN M. TILLES, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TILLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-8133
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:405
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-356-8133
Mailing Address - Fax:408-356-6923
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:405
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-356-8133
Practice Address - Fax:408-356-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G403890Medicare PIN
A48204Medicare UPIN