Individual
DAVID J TILSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 CENTRACARE CIR, SAINT CLOUD, MN 56303-5000
(320) 654-3630
(320) 654-3657
Mailing address
1900 CENTRACARE CIR, SAINT CLOUD, MN 56303-5000
(320) 654-3630
(320) 654-3657
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
37920
MN
208000000X
Pediatrics Physician
37920
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074814500
MEDICAL ASSISTANCE
—
01
—
1008055
PREFERRED ONE
—
01
—
110417
UCARE
—
01
—
1200086
MEDICA HEALTH PLANS
—
01
—
2089340
FIRST HEALTH PLAN
—
01
—
51A44TI
BLUE CROSS BLUE SHIELD
—
01
—
763003
ARAZ GROUP AMERICAS PPO
—
01
—
7713350
SOUTH DAKOTA MA
—
01
—
HP25528
HEALTH PARTNERS
—
Enumeration date
11/08/2005
Last updated
12/13/2011
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