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NPI Code Detail

MEDICARE: DR. FELICIA MAE TILLMAN M.D.

MEDICARE: DR. FELICIA MAE TILLMAN M.D.
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
1207V00000XObstetrics & Gynecology PhysicianG79172CA
2207V00000XObstetrics & Gynecology PhysicianK1100TX

General Provider Information

NPI Number : 1356343149
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FELICIA MAE TILLMAN M.D.
Provider Business Mailing Address
First Line : 555 REPUBLIC DR
Second Line : SUITE # 460
City : PLANO
State : TX
Zip : 75074-5481
Country : US
Telephone Number : 972-644-2819
Fax Number : 972-680-2949
Provider Business Practice Location Address
First Line : 4200 BECKNER RD
Second Line :
City : SANTA FE
State : NM
Zip : 87507-3774
Country : US
Telephone Number : 505-477-2200
Fax Number : 505-782-1902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 05/28/2025

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