Healthcare Provider Details

I. General information

NPI: 1154745230
Provider Name (Legal Business Name): RONALD TILMAN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 N 93RD ST
KANSAS CITY KS
66109-3003
US

IV. Provider business mailing address

4844 N 93RD ST
KANSAS CITY KS
66109-3003
US

V. Phone/Fax

Practice location:
  • Phone: 913-334-5888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: