Individual
WILLIAM TILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2248
Mailing address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2248
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
036085931
IL
207RP1001X
Pulmonary Disease Physician
Primary
81911-20
WI
207RP1001X
Pulmonary Disease Physician
83330
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085931
—
IL
05
—
833307
—
SC
Enumeration date
09/27/2005
Last updated
09/14/2023
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