Tiemann, Matthew Melvin

Tiemann, Matthew Melvin is an individual health care provider with primary practice located at 395 W Cougar Blvd , Provo UT 84604-3311. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Tiemann, Matthew Melvin can be contacted via phone (801) 373-7850.

Contact Information

Primary practice address
395 W Cougar Blvd Provo UT 84604-3311
Phone: (801) 373-7850
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 57636701206 Utah
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 57636701206 Utah

Profile Details

NPI number 1578992012
LBN Legal business name Tiemann, Matthew Melvin
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 5th, 2013
Last updated Nov 25th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578992012 NPPES
Utah MEDICAID 1578992012

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