Organization
KEVIN E TILL DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN E TILL DPM (PHYSICIAN)
(313) 831-6442
Entity
Organization
Contact information
Practice address
4160 JOHN R ST, STE 1012, DETROIT, MI 48201-2020
(313) 831-6442
(313) 831-6513
Mailing address
4160 JOHN R ST, STE 1012, DETROIT, MI 48201-2020
(313) 831-6442
(313) 831-6513
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901001067
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133113886
—
MI
Enumeration date
11/09/2006
Last updated
12/29/2010
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