Organization
TILLGES CERTIFIED ORTHOTIC PROSTHETIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT J TILLGES CPO, FAAOP (OWNER/PRESIDENT)
(651) 772-2665
Entity
Organization
Contact information
Practice address
817 PORTLAND AVE, MINNEAPOLIS, MN 55404-1145
(612) 341-3660
(612) 341-3664
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
—
01
—
102162
UCARE
—
01
—
21446
HEALTHPARTNERS
—
01
—
2G045TI
BLUE CROSS BLUE SHIELD
—
05
—
41783200
—
WI
05
—
78026500
—
MN
01
—
8200377
MEDICA
—
Enumeration date
01/16/2014
Last updated
01/16/2014
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