Provider Demographics
NPI:1144221136
Name:LIETZKE, CHRISTIANA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIANA
Middle Name:MARIE
Last Name:LIETZKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 CENTERPOINT BLVD STE 100
Mailing Address - Street 2:TEAMHEALTH
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1983
Mailing Address - Country:US
Mailing Address - Phone:800-539-0173
Mailing Address - Fax:
Practice Address - Street 1:1431 CENTERPOINT BLVD STE 100
Practice Address - Street 2:TEAMHEALTH
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1983
Practice Address - Country:US
Practice Address - Phone:800-539-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000038046207R00000X
OK30304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD0000038046OtherLICENSE
TNMD0000038046OtherLICENSE
TN3896365Medicare ID - Type Unspecified