Individual
WAYNE A TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
13011 S. 104TH AVE., SUITE 201, PALOS PARK, IL 60464-1512
(708) 923-0400
(708) 923-0600
Mailing address
13011 S. 104TH AVE., SUITE 201, PALOS PARK, IL 60464-1512
(708) 923-0400
(708) 923-0600
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004926
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1626136
BCBS
IL
01
—
2700614
UHC
IL
01
—
480034104
RAILROAD MC
IL
01
—
4861340001
DMGRC
IL
Enumeration date
11/22/2006
Last updated
11/01/2013
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