MEDICARE: MICHAEL WILLIAM TIEFF D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	OS002902L	PA

General Provider Information

NPI Number	:	1093942229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILLIAM TIEFF D.O.

Provider Business Mailing Address
First Line	:	843 BRIGHTON PL
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-3951
Country	:	US
Telephone Number	:	609-391-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 JFK BLVD
Second Line	:	APT 1903
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1502
Country	:	US
Telephone Number	:	570-620-6512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	06/15/2009

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