MEDICARE: DR. BRIAN T 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	207R00000X	Internal Medicine Physician	4301070159	MI

General Provider Information

NPI Number	:	1639154263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN T GIETZEN MD

Provider Business Mailing Address
First Line	:	1460 WALTON BLVD
Second Line	:	STE 200
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1768
Country	:	US
Telephone Number	:	248-650-1800
Fax Number	:	248-650-1856

Provider Business Practice Location Address
First Line	:	1460 WALTON BLVD
Second Line	:	STE 200
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1768
Country	:	US
Telephone Number	:	248-650-1800
Fax Number	:	248-650-1856

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	10/06/2020

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