Provider Demographics
NPI:1669643920
Name:FRANK TILARO INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:FRANK TILARO INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:TILARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-394-6569
Mailing Address - Street 1:425 E 5350 S
Mailing Address - Street 2:SUITE 335
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6946
Mailing Address - Country:US
Mailing Address - Phone:801-475-8600
Mailing Address - Fax:801-475-8686
Practice Address - Street 1:425 E 5350 S
Practice Address - Street 2:SUITE 335
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6946
Practice Address - Country:US
Practice Address - Phone:801-475-8600
Practice Address - Fax:801-475-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT178323-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000058010Medicare PIN
UTB82196Medicare UPIN