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NPI Code Detail

MEDICARE: DR. DAVID W DIETZ MD

MEDICARE: DR. DAVID W DIETZ 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
1208C00000XColon & Rectal Surgery Physician2001031151MO
2208C00000XColon & Rectal Surgery Physician332702NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578581039
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID W DIETZ MD
Provider Business Mailing Address
First Line : 6000 W CREEK RD
Second Line : SUITE 10
City : INDEPENDENCE
State : OH
Zip : 44131-2139
Country : US
Telephone Number : 216-444-5404
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 216-444-5404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 10/09/2024

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Directions to “ DR. DAVID W DIETZ MD” Practice Location

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