Provider Demographics
NPI:1346240843
Name:TIU, FREDELITO B (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDELITO
Middle Name:B
Last Name:TIU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:1702 W ANKLAM RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2606
Practice Address - Country:US
Practice Address - Phone:520-792-8300
Practice Address - Fax:520-792-8303
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2014-06-26
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Provider Licenses
StateLicense IDTaxonomies
AZ27319207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ621137Medicaid
AZ621137Medicaid
AZH46939Medicare UPIN