Individual
DR. DOUGLAS N TIETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
451 NW MURRAY RD, LEES SUMMIT, MO 64081-1425
(816) 524-1007
(816) 524-1988
Mailing address
451 NW MURRAY RD, LEES SUMMIT, MO 64081-1425
(816) 524-1007
(816) 524-1988
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0428228
KS
174400000X
Specialist
Primary
118291
MO
208800000X
Urology Physician
0428228
KS
208800000X
Urology Physician
Primary
118291
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205101
—
MO
01
—
25977052
BCBS
MO
01
—
340016722
RR MEDICARE
—
Enumeration date
05/08/2006
Last updated
04/23/2026
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