Healthcare Provider Details

I. General information

NPI: 1003096900
Provider Name (Legal Business Name): DR MARY TILAK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 CALUMET AVE STE 101
MUNSTER IN
46321-2812
US

IV. Provider business mailing address

PO BOX 736895
CHICAGO IL
60673-6895
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-8051
  • Fax: 219-922-8608
Mailing address:
  • Phone: 219-922-8051
  • Fax: 219-922-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY N. TILAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-922-8051