Individual
PAUL M KIETZMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
610 30TH AVE W, ALEXANDRIA, MN 56308-3426
(320) 763-5123
(320) 763-5749
Mailing address
610 30TH AVE W, ALEXANDRIA, MN 56308-3426
(320) 763-5123
(320) 763-5749
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49324
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-30293 149780561
MEDICA
MN
01
—
1497880561
NPI
—
01
—
49324
STATE MEDICAL LICENSE
MN
05
—
925198000
—
MN
01
—
A086
TRI-CARE
MN
01
—
HP86106
HEALTH PARTNERS
MN
01
—
NA9121053818
PREFERRED ONE
MN
Enumeration date
02/22/2007
Last updated
10/21/2024
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