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Individual

JANET K TILLISCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3300
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4237
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
015795300
ND
05
10168
ND
01
1201177
MEDICA #
ND
01
1201797
MEDICA #
ND
01
1203181
MEDICA #
ND
01
142074
UCARE #
ND
01
1877
NDBS #
ND
01
28064TI
MNBS #
ND
01
6419
NDBS #
MN
01
765120
AMERICA'S PPO/ARAZ #
ND
01
8253
SIOUX VALLEY #
ND
01
91423TI
MNBS #
ND
01
DA9011015596
PREFERRED ONE #
ND
01
HP19569
HEALTHPARTNERS #
ND
01
ND100012
LHS #
ND
Enumeration date
07/05/2006
Last updated
11/03/2011
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