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:
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Other - Credentials:
Mailing Address - Street 1:1177 QUEEN ST APT 4603
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4152
Mailing Address - Country:US
Mailing Address - Phone:406-606-2168
Mailing Address - Fax:084-330-2818
Practice Address - Street 1:860 IWILEI RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5018
Practice Address - Country:US
Practice Address - Phone:808-383-3996
Practice Address - Fax:808-791-8049
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005587207R00000X
MT40873207R00000X
HIDOS-2646207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1619188216Medicaid
AZ637117Medicaid
MT1619188216Medicaid