Charles a Tietz MD Facog LTD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

1287 Issued in MN

Legal business name

CHARLES A TIETZ MD FACOG LTD

Practice address

307 1St St S
Ste108
Virginia, MN 55792-2696

Phone

(218) 749-8326

Fax

(218) 749-8608

NPI assigned

May 24, 2007

Last updated

Jan 14, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Polly Lalonde

Title

Office Manager

Phone

(218) 749-8326

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1316158173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 1ST ST S",
            "address_2": "STE 108",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922696",
            "telephone_number": "218-749-8326",
            "fax_number": "218-749-8608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 1ST ST S",
            "address_2": "STE108",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922696",
            "telephone_number": "218-749-8326",
            "fax_number": "218-749-8608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A TIETZ MD FACOG LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "LALONDE",
        "authorized_official_first_name": "POLLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "218-749-8326"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "1287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01075TI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Virginia, MN
• Providers in Virginia, MN by specialty
• Obstetrics & Gynecology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.