Provider Demographics
NPI:1346459765
Name:TILLEMANS, TAD CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:TAD
Middle Name:CHRISTOPHER
Last Name:TILLEMANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4327
Mailing Address - Country:US
Mailing Address - Phone:501-660-6644
Mailing Address - Fax:501-603-9497
Practice Address - Street 1:2801 LEE AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4327
Practice Address - Country:US
Practice Address - Phone:501-660-6644
Practice Address - Fax:501-603-9497
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1436377001Medicaid