Provider Demographics
NPI:1922298579
Name:TILLMAN, SAULETTE RAQUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SAULETTE
Middle Name:RAQUEL
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAULETTE
Other - Middle Name:RAQUEL
Other - Last Name:QUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:6818 AUSTIN CENTER BLVD STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3100
Practice Address - Country:US
Practice Address - Phone:512-344-0450
Practice Address - Fax:512-406-7318
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6361207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE PIN
TX094010801OtherGROUP MEDICAID