Individual
DR. MARY N TILAK
Active
Individual
DR. MARY N TILAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01054662A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350970
ANTHEM
IN
01
—
000000541656
ANTHEM
IN
05
—
200339190
—
IN
01
—
90001352
BC/BS
IL
Enumeration date
10/05/2006
Last updated
04/24/2026
Update your record
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