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Individual

DR. DANIELLE MARIE DIETZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1138 LEXINGTON RD, SUITE 230, GEORGETOWN, KY 40324-9672
(502) 570-3778
(502) 570-3779
Mailing address
1138 LEXINGTON RD, SUITE 230, GEORGETOWN, KY 40324-9672
(502) 570-3778
(502) 570-3779

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
40300
KY
208600000X
Surgery Physician
TP770
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100003310
KY
Enumeration date
09/20/2006
Last updated
06/01/2016
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