Individual
DR. TIMOTHY J. KIETZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2015 N MAIN ST, WHEATON, IL 60187-3152
(630) 668-8250
Mailing address
2015 N MAIN ST, WHEATON, IL 60187-3152
(630) 668-8250
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036.073602
IL
207WX0109X
Neuro-ophthalmology Physician
Primary
036.073602
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-073602
—
IL
Enumeration date
07/28/2011
Last updated
08/21/2024
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