Provider Demographics
NPI:1356343149
Name:TILLMAN, FELICIA MAE (MD)
Entity type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:MAE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:TILLMAN
Other - Last Name:TOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:555 REPUBLIC DR
Mailing Address - Street 2:SUITE # 460
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5481
Mailing Address - Country:US
Mailing Address - Phone:972-644-2819
Mailing Address - Fax:972-680-2949
Practice Address - Street 1:4200 BECKNER RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3774
Practice Address - Country:US
Practice Address - Phone:505-477-2200
Practice Address - Fax:505-782-1902
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79172207V00000X
TXK1100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG31886Medicare UPIN
TX87T439Medicare ID - Type Unspecified