Thomas Tietjen, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

TT077247 Issued in MI

Practice address

560 W Mitchell St
Suite M40
Petoskey, MI 49770-2278

Phone

(231) 487-2391

Fax

(231) 487-6513

NPI assigned

Dec 12, 2006

Last updated

Dec 24, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Digestive Health Associates of Northern Michigan, P.C.

  • Gastroenterology Physician
  • Traverse City, MI
  • NPI 1225104011
  NPD (past)

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450915200000",
    "number": "1861553026",
    "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": "231-838-4044",
            "fax_number": "231-344-5923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "SUITE M40",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702278",
            "telephone_number": "231-487-2391",
            "fax_number": "231-487-6513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIETJEN",
        "first_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2015-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "TT077247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861553026",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Living Room
• The Men's Counseling Center of Northern Michigan, LLC
• Therapy Solutions LLC
• Alexa Taylor Thibault
• Daniel Thompson
• Timothy S Jarvi MD PC (Eye Specialists of Northern Michigan)
• Timothy S. Jarvi MD PC (Summit Park Optical)
• Kyrsee Tingstad
• Elise M Tippett, LMSW
• Maureen Todd

• 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 24, 2015; 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.