Individual
SCOTT J TILLESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
13900 W NATIONAL AVE, PROHEALTH CARE MEDICAL ASSOCIATES INC., NEW BERLIN, WI 53151-9515
(262) 928-4500
(262) 928-4550
Mailing address
N17 W24100 RIVERWOOD DRIVE SUITE 250, PROHEALTH CARE MEDICAL ASSOCIATES INC., WAUKESHA, WI 53188
(262) 928-4100
(262) 928-5835
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19446
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30040300
—
WI
Enumeration date
02/10/2006
Last updated
11/09/2011
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