Healthcare Provider Details

I. General information

NPI: 1700230703
Provider Name (Legal Business Name): MARAH TILLMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 CORAL WAY FL 4
MIAMI FL
33145-3229
US

IV. Provider business mailing address

3181 CORAL WAY FL 4
MIAMI FL
33145-3229
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-1002
  • Fax:
Mailing address:
  • Phone: 305-856-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME151340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: