Tietjen, Douglas N

Tietjen, Douglas N is an individual health care provider with primary practice located at 451 Nw Murray Rd , Lees Summit MO 64081-1425. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Tietjen, Douglas N can be contacted via phone (816) 524-1007.

Contact Information

Primary practice address
451 Nw Murray Rd Lees Summit MO 64081-1425
Phone: (816) 524-1007
Fax: (816) 524-1988
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0428228 Kansas
Other Service Providers / Specialist 174400000X 118291 Missouri

Profile Details

NPI number 1679522700
LBN Legal business name Tietjen, Douglas N
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 8th, 2006
Last updated Apr 14th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679522700 NPPES
Missouri MEDICAID 205101
Missouri Other 340016722
Missouri Other 25977052

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