Individual
DR. MICHAEL TILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(202) 425-2103
(215) 243-4605
Mailing address
117 E LULLWOOD AVE, SAN ANTONIO, TX 78212-2317
(202) 425-2103
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
4301075583
MI
208600000X
Surgery Physician
4301075583
MI
208600000X
Surgery Physician
MD457338
PA
2086S0102X
Surgical Critical Care Physician
MD457338
PA
2086S0127X
Trauma Surgery Physician
Primary
4301075583
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356306658
—
DC
Enumeration date
04/19/2006
Last updated
04/13/2020
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