Provider Demographics
NPI:1841292745
Name:TILLES, STEVEN M (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:TILLES
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4013
Mailing Address - Country:US
Mailing Address - Phone:408-356-8133
Mailing Address - Fax:408-356-6923
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:SUITE 405
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4013
Practice Address - Country:US
Practice Address - Phone:408-356-8133
Practice Address - Fax:408-356-6923
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG40389207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G403890Medicaid
00G403890Medicare ID - Type Unspecified
CA00G403890Medicaid