Healthcare Provider Details

I. General information

NPI: 1922298579
Provider Name (Legal Business Name): SAULETTE RAQUEL TILLMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAULETTE RAQUEL QUEEN M.D.

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 AUSTIN CENTER BLVD STE 205
AUSTIN TX
78731-3100
US

IV. Provider business mailing address

6210 E HWY 290
AUSTIN TX
78723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 512-344-0450
  • Fax: 512-406-7318
Mailing address:
  • Phone: 512-483-9596
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM6361
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: