Active NPI
Kyle Tietze
- Independent Duty Corpsman
- Duluth, MN
National Provider Identifier
1699507301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 1201 Minnesota Ave
Duluth, MN 55802-2424 - Phone
- (218) 529-3109
- NPI assigned
- Aug 20, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
1201 Minnesota Ave
Duluth, MN 55802-2424
Mailing address
1201 Minnesota Ave
Duluth, MN 55802-2424
Phone (218) 529-3109
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://access.mhsgenesis.health.mil/ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724112000000",
"number": "1699507301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 MINNESOTA AVE",
"city": "DULUTH",
"state": "MN",
"postal_code": "558022424",
"telephone_number": "218-529-3109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 MINNESOTA AVE",
"city": "DULUTH",
"state": "MN",
"postal_code": "558022424",
"telephone_number": "218-529-3109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIETZE",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-20",
"last_updated": "2024-08-20",
"certification_date": "2024-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://access.mhsgenesis.health.mil/",
"affiliation": "N",
"address_1": "1201 Minnesota Ave",
"city": "Duluth",
"state": "MN",
"country_code": "US",
"postal_code": "558022424",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.