Basic Information
Provider Information
NPI: 1871695684
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DILLARD
FirstName: TIFFANI
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 6004
Address2:  
City: URBANA
State: IL
PostalCode: 618036004
CountryCode: US
TelephoneNumber: 2173836792
FaxNumber:  
Practice Location
Address1: 602 W. UNIVERSITY AVENUE
Address2: OB/GYN
City: URBANA
State: IL
PostalCode: 61801
CountryCode: US
TelephoneNumber: 2173833140
FaxNumber: 2173834966
Other Information
ProviderEnumerationDate: 09/02/2006
LastUpdateDate: 06/05/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X036102146ILY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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