MEDICARE: ANTHONY TILLMAN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1407720154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY TILLMAN

Provider Business Mailing Address
First Line	:	3017 IVY HILL DR
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-5147
Country	:	US
Telephone Number	:	313-413-0451
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 IVY HILL DR
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-5147
Country	:	US
Telephone Number	:	313-413-0451
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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Directions to “ ANTHONY TILLMAN ” Practice Location

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