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1033719745
MITCHELL TIEDKE
ENGLEWOOD, CO
NPI
1033719745
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: CO PA.0006543)
Enumeration Date
2020-10-30
Last Update Date
2023-02-16
Business Address
MITCHELL TIEDKE PA
3501 S CLARKSON ST
ENGLEWOOD, CO 80113-3916
Phone number: 763-381-7160
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Mailing Address
MITCHELL TIEDKE PA
PO BOX 110429
AURORA, CO 80042-0429
Phone number:
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