Individual
EDWARD DAIL TILLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 ABRAHAM FLEXNER WAY, SUITE 100, LOUISVILLE, KY 40202
(502) 587-8222
(502) 587-0860
Mailing address
6801 DIXIE HWY, STE 130, LOUISVILLE, KY 40258-3913
(502) 587-7222
(502) 587-0860
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22228
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048044
ANTHEM / R G SHEA
KY
01
—
000000049351
ANTHEM/UNIV ORTHO ASSOC
KY
01
—
0773853
MEDICARE-UNSPECIFIED
KY
05
—
100374040
—
KY
01
—
1049630
PASSPORT/UNIV ORTHO ASSOC
KY
01
—
1071560
PASSPORT / R G SHEA
KY
01
—
200013351
RAILROAD MEDICARE / R G SHEA
KY
01
—
2432607000
PASSPORT ADV/UNIV ORTHO A
KY
01
—
2434923000
PASSPORT ADVANTAGE / R G SHEA
KY
01
—
4043364
AETNA / R G SHEA
KY
05
—
64222284
—
KY
Enumeration date
05/17/2006
Last updated
11/19/2010
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