Organization
CHARLES A TIETZ MD FACOG LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POLLY LALONDE (OFFICE MANAGER)
(218) 749-8326
Entity
Organization
Contact information
Practice address
307 1ST ST S, STE108, VIRGINIA, MN 55792-2696
(218) 749-8326
(218) 749-8608
Mailing address
307 1ST ST S, STE 108, VIRGINIA, MN 55792-2696
(218) 749-8326
(218) 749-8608
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
1287
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01075TI
BCBS
MN
Enumeration date
05/24/2007
Last updated
01/14/2008
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