Provider Demographics
NPI:1992091219
Name:ANDERSONTIERNAN INC
Entity type:Organization
Organization Name:ANDERSONTIERNAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRECK
Authorized Official - Middle Name:
Authorized Official - Last Name:TIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-553-0990
Mailing Address - Street 1:350 HOUBOLT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8305
Mailing Address - Country:US
Mailing Address - Phone:815-553-0990
Mailing Address - Fax:815-553-0991
Practice Address - Street 1:455 S ROSELLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-2971
Practice Address - Country:US
Practice Address - Phone:847-985-8380
Practice Address - Fax:847-985-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005321213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty