Provider Demographics
NPI:1821102484
Name:TILZER, SETH (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:TILZER
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 1:2112 BROOK HILL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7959
Mailing Address - Country:US
Mailing Address - Phone:636-394-2232
Mailing Address - Fax:636-394-1152
Practice Address - Street 1:2100 MADISON AVE.
Practice Address - Street 2:GATEWAY REGIONAL MEDICAL CENTER
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-798-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR-6G022084P0800X
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK30639Medicare PIN
MOA10495Medicare UPIN