Tierra Lakes Medical Group, LLC

NPI #1639628829 in Bel Aire, Kansas

Provider Information

NPI Number: 1639628829
Entity Type: Organization
Organization Name: Tierra Lakes Medical Group, LLC
Primary Specialty: Specialist
Enumeration Date: Sep 28, 2016
Last Updated: Sep 28, 2016

Practice Location

Address: 4969 N TIERRA LAKES PKWY
City: Bel Aire
State: Kansas
ZIP Code: 67226-3345
Phone: (316) 440-4820

Authorized Official

Name: JANNIFER TERRY, RN
Title: OWNER
Phone: (316) 440-4820

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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