Provider Demographics
NPI:1538178025
Name:GIETZEN, JOHN NICHOLAS (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:GIETZEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:W5491 WINDMILL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-9489
Mailing Address - Country:US
Mailing Address - Phone:608-518-3654
Mailing Address - Fax:928-277-4942
Practice Address - Street 1:W5491 WINDMILL RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9489
Practice Address - Country:US
Practice Address - Phone:608-518-3654
Practice Address - Fax:928-277-4942
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF100847814OtherPTAN
IL1487274247OtherNPI
AZZ178595OtherMEDICARE PTAN
AZ1176490003Medicare NSC