Individual
CAROL L LIETZAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
824 N 11TH ST, MONTEVIDEO, MN 56265-1629
(320) 269-6435
(320) 269-4494
Mailing address
824 N 11TH ST, MONTEVIDEO, MN 56265-1629
(320) 269-6435
(320) 269-4494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22399
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
716792000
—
MN
Enumeration date
07/07/2005
Last updated
06/10/2008
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