Individual
DR. JULIAH C TIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6583
(417) 269-6573
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2008006549
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204497507
—
MO
Enumeration date
07/02/2008
Last updated
07/15/2019
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