Individual
CHRISTOPHER C. TIETZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-7802
Mailing address
PO BOX 581700, SALT LAKE CITY, UT 84158-1700
(801) 213-3800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
183411-1205
UT
207RG0100X
Gastroenterology Physician
Primary
183411-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003045300
—
ID
01
—
100002311
RAILROAD MEDICARE
UT
05
—
10234
—
UT
Enumeration date
10/13/2006
Last updated
01/18/2008
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