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General NPI Number Information
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NPI Number | 1134166606
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Entity Type | Organization
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Legal Business Name | ERMIAS TILAHUN MD SC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 5015 N PAULINA ST STE 101
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City | CHICAGO
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State | IL
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Zip | 60640-2756
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Country | US
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Telephone | 773-907-3550
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Fax | 773-907-3566
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Provider Business Mailing Address
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Address Line | 1937 ROYAL BIRKDALE DR
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City | VERNON HILLS
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State | IL
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Zip | 60061-4572
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Country | US
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Telephone | 773-907-3550
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Fax | 773-907-3566
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ERMIAS TILAHUN
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Credential | M.D.
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Telephone | 773-907-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036094888
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License Number State | IL
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