Organization
TILLGES CERTIFIED ORTHOTIC PROSTHETIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT JAMES TILLGES CPO (OWNER, PRESIDENT)
(651) 772-2665
Entity
Organization
Contact information
Practice address
1570 BEAM AVE, SUITE 100, MAPLEWOOD, MN 55109-1166
(651) 772-2665
(651) 771-6553
Mailing address
1570 BEAM AVE, SUITE 100, MAPLEWOOD, MN 55109-1166
(651) 772-2665
(651) 771-6553
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1018417
PREFERRED ONE
MN
01
—
102162
UCARE
MN
01
—
21446
HEALTH PARTNERS
MN
01
—
2G045TI
BLUECROSS/BLUE SHIELD
MN
01
—
41783200
WISCONSIN MEDICAID
WI
01
—
54075
NORTH DAKOTA MEDICAID
ND
01
—
8200376
MEDICA
MN
Enumeration date
04/24/2006
Last updated
07/31/2007
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