Dr. Mary Tilak PC

Primary specialty

Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X

License

01054662A Issued in IN

Legal business name

DR. MARY TILAK PC

Practice address

209 East 86TH Avenue
Merrillville, IN 46322-2601

Phone

(219) 922-8051

Fax

(219) 922-8608

NPI assigned

Dec 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary N. Tilak, MD

Title

President

Phone

(219) 922-8051

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1356525133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 EAST 86TH AVENUE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "463222601",
            "telephone_number": "219-922-8051",
            "fax_number": "219-922-8608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 EAST 86TH AVENUE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "463222601",
            "telephone_number": "219-922-8051",
            "fax_number": "219-922-8608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MARY TILAK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "TILAK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-922-8051",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RB0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "IN",
            "license": "01054662A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obesity Medicine (Internal Medicine) Physician in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Obesity Medicine (Internal Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.