Provider Demographics
NPI:1275897225
Name:TILLEY, REGAN MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:REGAN
Middle Name:MICHELE
Last Name:TILLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:REGAN
Other - Middle Name:MICHELE
Other - Last Name:DULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7840 E US 24 HWY
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502
Mailing Address - Country:US
Mailing Address - Phone:785-775-1155
Mailing Address - Fax:785-775-1156
Practice Address - Street 1:7840 E US 24 HWY
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-775-1155
Practice Address - Fax:785-775-1156
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020612207Q00000X
KS05-38045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002327OtherMEDICARE PTAN