Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301084403 | MI |
NPI | 1033101225 |
---|---|
Provider Name | Dr. Tudor R Tien |
First Address | Detroit, MI 48267-0002 |
Second Address | Jackson, MI 49201-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0920018 | PHYSICIALS HEALTH PLAN (01) | MI |
2003810541 | BLUE CROSS BLUE SHIELD MI (01) | MI |
5392560001 | MEDICARE DMERC (01) | MI |
700C810580 | BC - FOOTE (01) | MI |
I16878 | (02) | MI |
P118495 | BLUE CARE NETWORK (01) | MA |