Provider Demographics
NPI:1427249564
Name:TIEMANN, KIRK JON (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:JON
Last Name:TIEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRK
Other - Middle Name:JON
Other - Last Name:BLANCAS-TIEMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8214 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0923
Mailing Address - Country:US
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:79424-0962
Practice Address - Country:US
Practice Address - Phone:806-795-6421
Practice Address - Fax:806-795-1528
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10021976207Q00000X
TXM9059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148706Medicare PIN