Organization
TOM TIETJEN MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS TIETJEN MD (MANAGER)
(231) 439-5491
Entity
Organization
Contact information
Practice address
267 CREEKSIDE DR, SUITE 200, PETOSKEY, MI 49770-7609
(231) 753-2105
(231) 344-5923
Mailing address
859 SURREY LN, PETOSKEY, MI 49770-9310
(231) 439-5491
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
4301077247
MI
Other
Enumeration date
09/30/2014
Last updated
12/12/2014
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