Healthcare Provider Details

I. General information

NPI: 1528996667
Provider Name (Legal Business Name): TIMOTHY C DIETZEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W SPENCER ST STE H
APPLETON WI
54914-4307
US

IV. Provider business mailing address

3121 W SPENCER ST STE H
APPLETON WI
54914-4307
US

V. Phone/Fax

Practice location:
  • Phone: 920-209-5553
  • Fax:
Mailing address:
  • Phone: 920-404-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: