Provider Demographics
NPI:1295714954
Name:TILLOTSON, CHRISTOPHER LEEDS (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEEDS
Last Name:TILLOTSON
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 1:7130 KENMARE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32368200Medicaid
MN48603TIOtherBLUE CROSS BLUE SHIELD OF MINNESOTA
MN100718OtherUCARE
MN1604147OtherMEDICA
IA7562520Medicaid
MN23018OtherAMERICA'S PPO
MN9246569OtherDAKOTA CARE
MN1021804OtherPREFERRED ONE
WI99112160OtherWI HEALTH INSURANCE RISK SHARING PLAN
WIP00437108OtherRAILROAD MEDICARE WI
MN300085357OtherRAILROAD MEDICARE MN
MN674795700Medicaid
MNHP14559OtherHEALTHPARTNERS
WI004456135Medicare PIN
MNE02463Medicare UPIN
WI300003908Medicare PIN
MN23018OtherAMERICA'S PPO
WI32368200Medicaid
MN300000367Medicare PIN