Provider Demographics
NPI:1609122084
Name:TISIUS, JAMES ROBERT III (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:TISIUS
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:18101 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4089
Mailing Address - Country:US
Mailing Address - Phone:313-593-7000
Mailing Address - Fax:313-436-2061
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-593-7000
Practice Address - Fax:313-436-2061
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2016-06-23
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Provider Licenses
StateLicense IDTaxonomies
MI4301101774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine