Provider Demographics
NPI:1235495102
Name:KIRK J TIEMANN,MD,PA
Entity type:Organization
Organization Name:KIRK J TIEMANN,MD,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:806-795-6421
Mailing Address - Street 1:8214 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424
Mailing Address - Country:UM
Mailing Address - Phone:806-795-6421
Mailing Address - Fax:806-795-1528
Practice Address - Street 1:8214 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0923
Practice Address - Country:US
Practice Address - Phone:806-795-6421
Practice Address - Fax:806-795-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty