Provider Demographics
NPI:1417912296
Name:TILWALLI, DHRUVA R (MD)
Entity Type:Individual
Prefix:DR
First Name:DHRUVA
Middle Name:R
Last Name:TILWALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W 755 BUTTERFIELD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-827-0100
Mailing Address - Fax:630-827-0103
Practice Address - Street 1:17 W 755 BUTTERFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4253
Practice Address - Country:US
Practice Address - Phone:630-827-0100
Practice Address - Fax:630-827-0103
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050661207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050661Medicaid
IL036050661/01Medicaid
IL995271OtherMEDICARE GROUP
IL21608842OtherBCBS IL
IL21608842OtherBCBS IL
IL036050661/01Medicaid
ILL27025Medicare PIN
ILL27027Medicare PIN