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General NPI Number Information
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NPI Number | 1235495102
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Entity Type | Organization
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Legal Business Name | KIRK J TIEMANN,MD,PA
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 8214 MILWAUKEE AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-0923
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Country | US
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Telephone | 806-795-6421
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Fax | 806-795-1528
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Provider Business Mailing Address
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Address Line | 8214 MILWAUKEE AVE
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City | LUBBOCK
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State | TX
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Zip | 79424
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Country | UM
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Telephone | 806-795-6421
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Fax | 806-795-1528
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Authorized Official
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Title or Position | OWNER
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Name | KIRK J TIEMANN
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Credential | MD,PA
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Telephone | 806-795-6421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M9059
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License Number State | TX
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