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NPI Code Detail

MEDICARE: KATHERINE LIETZ MD PHD

MEDICARE: KATHERINE LIETZ MD PHD
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
1207RA0001XAdvanced Heart Failure and Transplant Cardiology PhysicianME166042FL
2207RA0001XAdvanced Heart Failure and Transplant Cardiology Physician0101252774VA
3207RC0000XCardiovascular Disease Physician127613IL
4207RC0000XCardiovascular Disease PhysicianME166042FL

Other Identifiers

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

General Provider Information

NPI Number : 1194864157
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE LIETZ MD PHD
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-5820
Fax Number : 239-343-4098
Provider Business Practice Location Address
First Line : 9981 S HEALTHPARK DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3618
Country : US
Telephone Number : 239-343-5820
Fax Number : 239-343-4098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 06/26/2026

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