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NPI Code Detail

MEDICARE: DR. CHRISTOPHER T DIETRICH MD

MEDICARE: DR. CHRISTOPHER T DIETRICH 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
1208VP0014XInterventional Pain Medicine Physician5661SD
2208100000XPhysical Medicine & Rehabilitation Physician5661SD

General Provider Information

NPI Number : 1063403905
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER T DIETRICH MD
Provider Business Mailing Address
First Line : PO BOX 6850
Second Line :
City : RAPID CITY
State : SD
Zip : 57709-6850
Country : US
Telephone Number :
Fax Number : 605-341-7062
Provider Business Practice Location Address
First Line : 4141 5TH ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-6021
Country : US
Telephone Number : 605-341-1414
Fax Number : 605-341-7062
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 07/16/2024

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