Provider Demographics
NPI:1073680278
Name:TILLAN, MARIA D (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:TILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1425 SOUTH OSPREY AVE
Mailing Address - Street 2:INFECTIOUS DIEASES ASSOCIATES
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2900
Mailing Address - Country:US
Mailing Address - Phone:941-366-9060
Mailing Address - Fax:941-953-7076
Practice Address - Street 1:1425 SOUTH OSPREY AVE
Practice Address - Street 2:INFECTIOUS DIEASES ASSOCIATES
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2900
Practice Address - Country:US
Practice Address - Phone:941-366-9060
Practice Address - Fax:941-953-7076
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 89919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist