Provider Demographics
NPI:1780071340
Name:KWIECIEN, TIMOTHY DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:KWIECIEN
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 1:215 E MANSION ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1167
Mailing Address - Country:US
Mailing Address - Phone:269-789-4386
Mailing Address - Fax:269-789-4387
Practice Address - Street 1:215 E MANSION ST STE 2C
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1167
Practice Address - Country:US
Practice Address - Phone:269-789-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57246977207LP2900X
CAA145257207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine