Provider Demographics
NPI:1861486540
Name:TIEMAN, SARAH A (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:TIEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:812-353-3087
Mailing Address - Fax:812-353-5859
Practice Address - Street 1:514 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2316
Practice Address - Country:US
Practice Address - Phone:812-353-4719
Practice Address - Fax:812-353-3713
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055106A208000000X, 207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200383900AMedicaid
IN000000224576OtherANTHEM PROVIDER #
940070D5Medicare ID - Type Unspecified
IN200383900AMedicaid