Individual
DR. MARCUS ADAM TIELKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8075 N SHADELAND AVE, SUITE 200, INDIANAPOLIS, IN 46250-2693
(317) 887-7880
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
01064146A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01210508
RR MEDICARE PTAN
IN
Enumeration date
12/04/2008
Last updated
12/05/2014
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