Individual
TIMOTHY EDWARD LIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211-0035
(704) 319-5821
(704) 377-2687
Mailing address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211-0035
(704) 319-5821
(704) 377-2687
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
94-00898
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5191A
BCBSNC
NC
05
—
89-5191A
—
NC
01
—
930067615
RR MEDICARE
NC
05
—
N00898
—
SC
Enumeration date
05/18/2006
Last updated
08/23/2023
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