Carol L Lietzau, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22399 Issued in MN

Practice address

824 N 11TH St
Montevideo, MN 56265-1629

Phone

(320) 269-6435

Fax

(320) 269-4494

NPI assigned

Jul 7, 2005

Last updated

Jun 10, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carol L. Johansen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1407853211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-6435",
            "fax_number": "320-269-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-6435",
            "fax_number": "320-269-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIETZAU",
        "first_name": "CAROL",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "22399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "716792000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "JOHANSEN",
            "middle_name": "L.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Arnold J Lande, MD
• Hailey Lynn Larson
• Cheryl Jean Lee, LPN
• Te'Neil J Lee, LGSW, LADC
• Thomas G Lewison, CRNA
• Leah Lines
• Allison Lynn Lockman
• Charla Ann Loose
• Shayna Marie Lovdahl, PA-C
• Kirsten Lee Lundy

• Family Medicine Physician in Montevideo, MN
• Providers in Montevideo, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.