MEDICARE: DR. JOHN MICHAEL TILLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G0208	TX

General Provider Information

NPI Number	:	1164420691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL TILLEY M.D.

Provider Business Mailing Address
First Line	:	2300 HIGHLAND VILLAGE RD
Second Line	:	STE 600
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-7148
Country	:	US
Telephone Number	:	972-317-0331
Fax Number	:	972-317-3811

Provider Business Practice Location Address
First Line	:	2300 HIGHLAND VILLAGE RD
Second Line	:	STE 600
City	:	HIGHLAND VILLAGE
State	:	TX
Zip	:	75077-7148
Country	:	US
Telephone Number	:	972-317-0331
Fax Number	:	972-317-3811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/21/2021

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