Provider Demographics
NPI:1427015031
Name:TIESI, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:TIESI
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 1:200 3RD AVE W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8626
Mailing Address - Country:US
Mailing Address - Phone:941-794-3118
Mailing Address - Fax:941-782-2017
Practice Address - Street 1:200 3RD AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8626
Practice Address - Country:US
Practice Address - Phone:941-794-3118
Practice Address - Fax:941-782-2017
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59348207T00000X, 2085R0202X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264537800Medicaid
FL264534300Medicaid
FL12453ZMedicare PIN
FLE90619Medicare UPIN
FL264534300Medicaid