Individual
THOMAS TIETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
560 W MITCHELL ST, SUITE M40, PETOSKEY, MI 49770-2278
(231) 487-2391
(231) 487-6513
Mailing address
859 SURREY LN, PETOSKEY, MI 49770-9310
(231) 838-4044
(231) 344-5923
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
TT077247
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861553026
—
MI
Enumeration date
12/12/2006
Last updated
12/24/2015
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