Provider Demographics
NPI:1528155215
Name:TILLE, KATHERINE SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:TILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1120 WELLINGTON AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6131
Mailing Address - Country:US
Mailing Address - Phone:970-241-0170
Mailing Address - Fax:970-241-2035
Practice Address - Street 1:1120 WELLINGTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-241-0170
Practice Address - Fax:970-241-2035
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059691207K00000X
VA0101241678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics