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NPI Code Detail

MEDICARE: TILU THOMAS

MEDICARE: TILU THOMAS
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
1363L00000XNurse Practitioner1059332TX

General Provider Information

NPI Number : 1639839103
Entity Type Code : Individual
Provider Name (Legal Business Name) : TILU THOMAS
Provider Business Mailing Address
First Line : 4370 MEDICAL ARTS DR STE 295
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-1742
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4370 MEDICAL ARTS DR STE 295
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-1742
Country : US
Telephone Number : 972-691-3777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2021
Last Update Date : 01/02/2022

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Directions to “ TILU THOMAS ” Practice Location

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