Healthcare Provider Details

I. General information

NPI: 1033101225
Provider Name (Legal Business Name): TUDOR R TIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TUDOR R TIEN M.D.

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date: 03/22/2006
Reactivation Date: 04/27/2006

III. Provider practice location address

1201 E MICHIGAN AVE SUITE 300
JACKSON MI
49201-1852
US

IV. Provider business mailing address

PO BOX 67000 DEPARTMENT 272801
DETROIT MI
48267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 517-841-1431
  • Fax: 517-841-1432
Mailing address:
  • Phone: 517-841-1431
  • Fax: 517-841-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301084403
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301084403
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: