Provider Demographics
NPI:1437300712
Name:TAD TILLEMANS, P.A.
Entity Type:Organization
Organization Name:TAD TILLEMANS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEMANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-660-6644
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2889251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health