Provider Demographics
NPI:1437252947
Name:TILLEROS, ELISABETH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:ANNE
Last Name:TILLEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 WESTCHESTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6117
Mailing Address - Country:US
Mailing Address - Phone:972-993-5040
Mailing Address - Fax:972-993-5041
Practice Address - Street 1:8215 WESTCHESTER DR STE 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6117
Practice Address - Country:US
Practice Address - Phone:972-993-5040
Practice Address - Fax:972-993-5041
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200689201Medicaid
MD359420300Medicaid
TXP00910175Medicare PIN
TX8L8609Medicare PIN
TX200689201Medicaid