Provider Demographics
NPI:1194859108
Name:VIETZ, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:VIETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 WILKENS AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5218
Mailing Address - Country:US
Mailing Address - Phone:410-464-4125
Mailing Address - Fax:410-644-6232
Practice Address - Street 1:3449 WILKENS AVE STE 305
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-464-4125
Practice Address - Fax:410-644-6232
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041539207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774011500Medicaid
MD236929YBDBMedicare PIN
MD129PMedicare ID - Type Unspecified
MD52385505OtherBLUECROSS BLUESHIELD
MD6810328OtherCIGNA
MDK5960001OtherFEDERAL BCBS
MDK5960001OtherCAREFIRST BLUECHOICE