Provider Demographics
NPI:1619188216
Name:DIETRICH, KATHERINE LYNNE METZGER (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LYNNE METZGER
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 310W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6900
Mailing Address - Fax:406-238-6939
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 310W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6900
Practice Address - Fax:406-238-6939
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005587207R00000X
MT40873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1619188216Medicaid
AZ637117Medicaid
MT1619188216Medicaid