Healthcare Provider Details

I. General information

NPI: 1437835493
Provider Name (Legal Business Name): TANHITA HILALY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N 9TH STREET
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

P.O. BOX 19640
SPRINGFIELD IL
62702
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-7958
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125082735
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: