Individual
DR. BRIAN TILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9555 76TH ST STE 4105, PLEASANT PRAIRIE, WI 53158-1984
(262) 577-8080
(262) 577-8081
Mailing address
9555 76TH ST # 4105, PLEASANT PRAIRIE, WI 53158-1984
(262) 577-8080
(262) 577-8081
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
69543-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69543-20
WI LICENSE
WI
Enumeration date
03/28/2016
Last updated
07/16/2020
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