Individual
DR. RICHARD ELMER TIELKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 HOBSON RD, FORT WAYNE, IN 46805-4802
(260) 422-2481
(260) 969-3067
Mailing address
1900 CAREW ST., SUITE 1, FORT WAYNE, IN 46805-4765
(260) 373-9728
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01024664A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595591
ANTHEM
IN
05
—
100369420A
—
IN
01
—
P00698399
MEDICARE RR
IN
Enumeration date
08/21/2006
Last updated
09/21/2009
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