Individual
JAMES D DIETHELM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7640 SYLVANIA AVENUE, #100, SYLVANIA, OH 43560
(419) 473-2273
(419) 473-0474
Mailing address
4235 SECOR RD, TOLEDO, OH 43623
(419) 473-3561
(419) 473-0474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35041896
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411969
—
OH
01
—
080164173
RAILROAD MEDICARE
OH
Enumeration date
06/14/2005
Last updated
05/01/2012
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