Individual
JEREMY DAVID TILLIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5000 MACARTHUR BLVD, PMB 9002, OAKLAND, CA 94613-1301
(925) 884-2365
(925) 884-2375
Mailing address
5000 MACARTHUR BLVD, PMB 9002, OAKLAND, CA 94613-1301
(925) 884-2365
(925) 884-2375
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G57659
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G576590
BLUE SHIELD
CA
05
—
00G576590
—
CA
Enumeration date
11/07/2005
Last updated
03/29/2013
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