Individual
LISA DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6507 TOWN CENTER DR, SUITE A, CLARKSTON, MI 48346-4826
(248) 922-9975
(248) 922-9143
Mailing address
6507 TOWN CENTER DR, SUITE A, CLARKSTON, MI 48346-4826
(248) 922-9975
(248) 922-9143
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LD011820
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4225528
—
MI
Enumeration date
10/14/2005
Last updated
02/19/2013
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