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General NPI Number Information
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NPI Number | 1619396579
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Entity Type | Individual
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Provider Name | TARA STREICH-TILLES MD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 3333 BURNET AVENUE MLC 2026
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-9400
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Fax | 513-636-0166
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Provider Business Mailing Address
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Address Line | 3333 BURNET AVENUE MLC 2026
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-9400
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Fax | 513-636-0166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 35.133617
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License Number State | OH
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