MEDICARE: ROBERT SIDNEY TILLETT JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	20266	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50030136	OTHER	KY	PASSPORT/PASSPORT ADVANTAGE - NNS
2	000000693343	OTHER	KY	ANTHEM - NNS
3	118916	OTHER	KY	SIHO - NNS
4	000057043W	OTHER	KY	HUMANA - NNS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2542960	OTHER	KY	CIGNA - NNS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134109465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SIDNEY TILLETT JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-272-5395
Fax Number	:	502-272-5339

Provider Business Practice Location Address
First Line	:	3991 DUTCHMANS LN STE 310
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4716
Country	:	US
Telephone Number	:	502-899-6782
Fax Number	:	502-899-6783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	04/15/2021

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