Provider Demographics
NPI:1760450456
Name:DIETZLER, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:DIETZLER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2651 HILLCREST DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-4439
Mailing Address - Country:US
Mailing Address - Phone:715-531-6800
Mailing Address - Fax:715-531-6801
Practice Address - Street 1:525 N KNOWLES AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1218
Practice Address - Country:US
Practice Address - Phone:715-531-6800
Practice Address - Fax:715-531-6801
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI48541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine