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General NPI Number Information
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NPI Number | 1598576613
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Entity Type | Organization
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Legal Business Name | TILLGES CERTIFIED ORTHOTIC PROSTHETIC, INC.
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 3879 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2518
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Country | US
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Telephone | 651-772-2665
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 BEAM AVE STE 100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-3136
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Country | US
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Telephone | 651-772-2665
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Fax |
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Authorized Official
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Title or Position | OPERATIONS OFFICER
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Name | THOMAS TILLGES
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Credential |
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Telephone | 651-379-5581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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