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Individual

DR. CHARLES ALBIN TIETZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
307 1ST ST S, STE 108, VIRGINIA, MN 55792-2696
(218) 749-8326
(218) 749-8608
Mailing address
307 1ST ST S, STE 108, VIRGINIA, MN 55792-2696
(218) 749-8326
(218) 749-8608

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
15922
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
07-02849
MEDICA
MN
01
77163TI
BCBS
MN
Enumeration date
07/07/2005
Last updated
01/14/2008
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