Individual
MICHAEL EDWARD TIEMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5171 CUB LAKE RD, SUITE 280, SHOW LOW, AZ 85901-7866
(928) 532-5463
(928) 532-8474
Mailing address
PO BOX 1660, LAKESIDE, AZ 85929-1660
(928) 532-5463
(928) 532-8474
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
22553
WI
208600000X
Surgery Physician
Primary
27787
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
478942
—
AZ
01
—
AZ0732060
BLUE CROSS BLUE SHIELD AZ
AZ
Enumeration date
01/30/2006
Last updated
03/07/2023
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