Tom Tietjen MD PLLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

4301077247 Issued in MI

Legal business name

TOM TIETJEN MD PLLC

Practice address

267 Creekside Dr
Suite 200
Petoskey, MI 49770-7609

Phone

(231) 753-2105

Fax

(231) 344-5923

NPI assigned

Sep 30, 2014

Last updated

Dec 12, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas Tietjen, MD

Title

Manager

Phone

(231) 439-5491

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418342400000",
    "number": "1518360916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 SURREY LN",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497709310",
            "telephone_number": "231-439-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 CREEKSIDE DR",
            "address_2": "SUITE 200",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497707609",
            "telephone_number": "231-753-2105",
            "fax_number": "231-344-5923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOM TIETJEN MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-30",
        "last_updated": "2014-12-12",
        "status": "A",
        "authorized_official_last_name": "TIETJEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "231-439-5491",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301077247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Gastroenterology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.