MEDICARE: ERMIAS TILAHUN MD SC

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	207R00000X	Internal Medicine Physician	036094888	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209748	OTHER	IL	PTAN

General Provider Information

NPI Number	:	1134166606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERMIAS TILAHUN MD SC

Provider Business Mailing Address
First Line	:	1937 ROYAL BIRKDALE DR
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4572
Country	:	US
Telephone Number	:	773-907-3550
Fax Number	:	773-907-3566

Provider Business Practice Location Address
First Line	:	5015 N PAULINA ST STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2756
Country	:	US
Telephone Number	:	773-907-3550
Fax Number	:	773-907-3566

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ERMIAS TILAHUN
Credential	:	M.D.
Telephone Number	:	773-907-3550

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/06/2021

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