Individual
DR. CHARLES ALBERT DIETZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 DELAWARE STREET SE, PWB 1ST FL CINIC 1D UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 273-6004
(612) 273-8459
Mailing address
420 DELAWARE STREET SE, MMC 292 UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 626-3345
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32379
MN
2085R0204X
Vascular & Interventional Radiology Physician
32379
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0058344
—
MT
01
—
1010250
PREFERRED ONE
MN
01
—
105551
UCARE
MN
01
—
16-02032
MEDICA PRIMARY
MN
01
—
16-09449
MEDICA CHOICE
MN
01
—
17Y63DI
BCBS
MN
01
—
868089
ARAZ
MN
01
—
869302100
MN MA
MN
01
—
HP22169
HEALTHPARTNERS
MN
Enumeration date
07/05/2006
Last updated
05/01/2012
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