Provider Demographics
NPI:1548643109
Name:DIETRICH, CAITLIN C (DPM)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:C
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:340 HEALD WAY BLDG 100
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-6087
Mailing Address - Country:US
Mailing Address - Phone:352-259-1919
Mailing Address - Fax:352-259-2042
Practice Address - Street 1:340 HEALD WAY STE 100
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-6000
Practice Address - Country:US
Practice Address - Phone:352-259-1919
Practice Address - Fax:352-259-2042
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006658213ES0103X
FLPO4016213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery