Individual
DR. JOHN NICHOLAS GIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
W5491 WINDMILL RIDGE RD, NEW GLARUS, WI 53574-9489
(608) 518-3654
(928) 277-4942
Mailing address
W5491 WINDMILL RIDGE RD, NEW GLARUS, WI 53574-9489
(608) 518-3654
(928) 277-4942
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4158
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487274247
NPI
IL
01
—
F100847814
PTAN
WI
01
—
Z178595
MEDICARE PTAN
AZ
Enumeration date
08/05/2006
Last updated
11/28/2022
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