MEDICARE: DR. ELISABETH ANNE TILLEROS MD

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	207R00000X	Internal Medicine Physician	N1919	TX

General Provider Information

NPI Number	:	1437252947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELISABETH ANNE TILLEROS MD

Provider Business Mailing Address
First Line	:	8222 DOUGLAS AVE STE 600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5937
Country	:	US
Telephone Number	:	972-993-5040
Fax Number	:	972-993-5041

Provider Business Practice Location Address
First Line	:	8222 DOUGLAS AVE STE 600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5937
Country	:	US
Telephone Number	:	972-993-5040
Fax Number	:	972-993-5041

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	12/12/2025

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