Provider Demographics
NPI:1568483246
Name:MACIEJ TUMIEL MD PA
Entity Type:Organization
Organization Name:MACIEJ TUMIEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MACIEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-784-8007
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0527
Mailing Address - Country:US
Mailing Address - Phone:850-784-8007
Mailing Address - Fax:850-784-1090
Practice Address - Street 1:2101 NORTHSIDE DR
Practice Address - Street 2:UNIT 603
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3685
Practice Address - Country:US
Practice Address - Phone:850-784-8007
Practice Address - Fax:850-784-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66733207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25746OtherBCBS FLORIDA
FL25746OtherBCBS FLORIDA