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DR. BRIAN TILLIS MD NPI 1396107405


NPI Information

NPI: 1396107405
Provider Name: DR. BRIAN TILLIS, MD
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
9555 76TH ST STE 4105
PLEASANT PRAIRIE, WI
ZIP 53158
Phone: (262) 577-8080
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DR. Brian Tillis, MD is an obstetrics gynecology in Pleasant Prairie, WI with 8 years of experience. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. DR. Brian Tillis, MD NPI is 1396107405. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2016

The provider's business location address is:

9555 76TH ST STE 4105
PLEASANT PRAIRIE, WI
ZIP 53158-984
Phone: (262) 577-8080
Fax: (262) 577-8081

The NPI 1396107405 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/28/2016 and was last updated on 7/16/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & Gynecology69543-20WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
169543-20OTHERWISCONSINWI LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.