Individual
JEFFREY D TIEMSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
W3985 COUNTY ROAD NN, ELKHORN, WI 53121-4337
(262) 741-2000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 741-2121
(262) 741-2117
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64749
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100049570
—
WI
Enumeration date
08/16/2006
Last updated
08/07/2023
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