Individual
DR. DOUGLAS PAUL DIETZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4660 S HAGADORN RD, SUITE 420, EAST LANSING, MI 48823-5376
(517) 884-6100
(517) 884-6233
Mailing address
804 SERVICE RD # A201, EAST LANSING, MI 48824-7015
(517) 884-2676
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
5101011314
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912934761
—
MI
05
—
3379305
—
MI
Enumeration date
06/27/2006
Last updated
08/22/2016
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