Individual
THOMAS GIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
560 W MITCHELL ST, SUITE G40, PETOSKEY, MI 49770-2275
(231) 487-2391
(231) 487-6513
Mailing address
4100 PARK FOREST DR, SUITE 208, TRAVERSE CITY, MI 49684-7331
(231) 935-9060
(231) 935-9055
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
TG030269
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4109215
—
MI
01
—
OB81010
BCBSM
MI
Enumeration date
12/13/2006
Last updated
07/08/2007
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