Provider Demographics
NPI:1992812606
Name:TIESZEN, STUART CARL (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:CARL
Last Name:TIESZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:POB #311
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6898
Mailing Address - Country:US
Mailing Address - Phone:205-329-7805
Mailing Address - Fax:205-329-7806
Practice Address - Street 1:2018 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:POB #311
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6898
Practice Address - Country:US
Practice Address - Phone:205-329-7808
Practice Address - Fax:205-329-7807
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000129182084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051099489OtherFEDERAL BLUE CROSS
AL260040675OtherRAILROAD MEDICARE
AL168112100OtherUS DEPARTMENT OF LABOR
AL45550OtherUNITED HEALTH CARE/UBH
AL051041027OtherBLUE CROSS- BLUE SHIELD
ALC75916Medicare UPIN
AL168112100OtherUS DEPARTMENT OF LABOR