Provider Demographics
NPI:1245227966
Name:GIETZEN, PAUL E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:GIETZEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:781 LAKESHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1561
Mailing Address - Country:US
Mailing Address - Phone:517-265-0600
Mailing Address - Fax:517-263-0024
Practice Address - Street 1:781 LAKESHIRE TRL
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1561
Practice Address - Country:US
Practice Address - Phone:517-263-2187
Practice Address - Fax:517-263-0024
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1911803Medicaid
MI0460103Medicare ID - Type Unspecified
MI1911803Medicaid
MIA76304Medicare UPIN