Individual
KEVIN TIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 632-9236
Mailing address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
288442
MA
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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