MEDICARE: DR. ROGER CURTIS GIETZEN 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	2084N0400X	Neurology Physician	4301078507	MI

General Provider Information

NPI Number	:	1508808072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER CURTIS GIETZEN MD

Provider Business Mailing Address
First Line	:	3630 - B THORNVILLE RD.
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455
Country	:	US
Telephone Number	:	231-487-2220
Fax Number	:	231-487-6597

Provider Business Practice Location Address
First Line	:	3630-B THORNVILLE RD.
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455
Country	:	US
Telephone Number	:	231-487-2220
Fax Number	:	231-487-6597

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/16/2015

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