Provider Demographics
NPI:1073783569
Name:TIE QIAN MD PA
Entity Type:Organization
Organization Name:TIE QIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-746-4980
Mailing Address - Street 1:10481 NW 48TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4202
Mailing Address - Country:US
Mailing Address - Phone:954-746-4980
Mailing Address - Fax:954-746-4981
Practice Address - Street 1:8890 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7235
Practice Address - Country:US
Practice Address - Phone:954-746-4980
Practice Address - Fax:954-746-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13199Medicare PIN