Individual
MITCHELL TIEDKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3501 S CLARKSON ST, ENGLEWOOD, CO 80113-3916
(763) 381-7160
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.0006543
CO
Other
Enumeration date
10/30/2020
Last updated
02/16/2023
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