Provider Demographics
NPI:1720146400
Name:TILOT, THOMAS CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHARLES
Last Name:TILOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 BULL VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7434
Mailing Address - Country:US
Mailing Address - Phone:815-385-1101
Mailing Address - Fax:815-385-6953
Practice Address - Street 1:5435 BULL VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7434
Practice Address - Country:US
Practice Address - Phone:815-385-1101
Practice Address - Fax:815-385-6953
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-093581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5626580OtherBLUE CROSS BLUE SHIELD
IL036093581Medicaid
IL036093581Medicaid