MEDICARE: KATHRYN E DIETZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101053428	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427147396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN E DIETZ MD

Provider Business Mailing Address
First Line	:	2418 W INDIAN TRL STE F
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-1590
Country	:	US
Telephone Number	:	630-907-0578
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PIDGEON HILL DR STE 208
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-6134
Country	:	US
Telephone Number	:	703-539-6059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/19/2019

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Directions to “ KATHRYN E DIETZ MD” Practice Location

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