MEDICARE: ROGER C. GIETZEN, M.D., P.C.

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	:	1588695993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER C. GIETZEN, M.D., P.C.

Provider Business Mailing Address
First Line	:	3630B THORNVILLE RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-9399
Country	:	US
Telephone Number	:	586-838-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	3630B THORNVILLE RD
Second Line	:
City	:	METAMORA
State	:	MI
Zip	:	48455-9399
Country	:	US
Telephone Number	:	586-838-0404
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER CURTIS GIETZEN
Credential	:	M.D.
Telephone Number	:	586-838-0404

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/04/2014

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