Provider Demographics
NPI:1417984956
Name:TILLES, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TILLES
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 1:9725 3RD AVE NE STE 500
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2024
Mailing Address - Country:US
Mailing Address - Phone:206-527-1200
Mailing Address - Fax:206-527-2514
Practice Address - Street 1:9725 3RD AVE NE STE 500
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2024
Practice Address - Country:US
Practice Address - Phone:206-527-1200
Practice Address - Fax:206-527-2514
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038961207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA030004970OtherRAIL ROAD MEDICARE
WA030005045OtherRAILROAD MEDICAL
WA8174450Medicaid
WA030005046OtherRAILROAD MEDICARE
WA2079TIOtherREGENCE
WA8174450Medicaid
WA2079TIOtherREGENCE