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General NPI Number Information
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NPI Number | 1093942229
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Entity Type | Individual
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Provider Name | MICHAEL WILLIAM TIEFF D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 1901 JFK BLVD APT 1903
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City | PHILADELPHIA
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State | PA
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Zip | 19103-1502
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Country | US
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Telephone | 570-620-6512
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Fax |
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Provider Business Mailing Address
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Address Line | 843 BRIGHTON PL
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City | OCEAN CITY
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State | NJ
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Zip | 08226-3951
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Country | US
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Telephone | 609-391-0706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS002902L
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License Number State | PA
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