Provider Demographics
NPI:1922298579
Name:TILLMAN, SAULETTE RAQUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAULETTE
Middle Name:RAQUEL
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAULETTE
Other - Middle Name:RAQUEL
Other - Last Name:QUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7901 METROPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-3111
Mailing Address - Country:US
Mailing Address - Phone:512-823-4020
Mailing Address - Fax:
Practice Address - Street 1:7901 METROPOLIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-3111
Practice Address - Country:US
Practice Address - Phone:512-823-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6361207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094010801OtherGROUP MEDICAID
TX00J21AOtherGROUP MEDICARE PIN