Individual
DR. MARY N TILAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9410 CALUMET AVE, STE 101, MUNSTER, IN 46321-2812
(219) 922-8051
(219) 922-8608
Mailing address
PO BOX 736895, CHICAGO, IL 60673-6895
(219) 922-8051
(219) 922-8608
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
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