MEDICARE: MARIE CLARE 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
1	208000000X	Pediatrics Physician	35052933D	OH

General Provider Information

NPI Number	:	1518034578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE CLARE DIETRICH MD

Provider Business Mailing Address
First Line	:	7713 WAKE ROBIN DRIVE
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-845-8739
Fax Number	:

Provider Business Practice Location Address
First Line	:	KAISER PERMANENTE NORTH POINT TOWER SUITE 1200
Second Line	:	1001 LAKESIDE AVE
City	:	CLEVELAND
State	:	OH
Zip	:	44114-1153
Country	:	US
Telephone Number	:	216-621-5600
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/07/2023

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Directions to “ MARIE CLARE DIETRICH MD” Practice Location

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