Individual
CHARLES JOSEPH DIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
705 RILEY HOSPITAL DR, RI 3146, INDIANAPOLIS, IN 46202-5109
(317) 944-2353
(317) 944-2390
Mailing address
PO BOX 1026, INDIANAPOLIS, IN 46206-1026
(317) 274-1201
(317) 278-9905
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
01036773A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100284930
—
IN
Enumeration date
01/31/2006
Last updated
12/18/2013
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