Provider Demographics
NPI:1558353581
Name:TILLMAN, CRAIG P (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:P
Last Name:TILLMAN
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 1:615 VALLEY VIEW DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6180
Mailing Address - Country:US
Mailing Address - Phone:309-762-1072
Mailing Address - Fax:309-762-1094
Practice Address - Street 1:615 VALLEY VIEW DR.
Practice Address - Street 2:SUITE 202
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6180
Practice Address - Country:US
Practice Address - Phone:309-762-1072
Practice Address - Fax:309-762-1094
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63897-202085R0202X
IA259472085R0202X, 2085R0204X
IL036-0606322085R0202X, 2085R0204X
MOR8A792085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0850Medicare PIN
IL209395001Medicare PIN
ILL27301Medicare PIN
C43855Medicare UPIN
C43855Medicare UPIN