Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 038845 | CT |
NPI | 1134160435 |
---|---|
Provider Name | Alan Dietzek |
First Address | Danbury, CT 06810-4032 |
Second Address | Danbury, CT 06810-4032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038845 | CONNECTICARE (01) | CT |
0V7532 | HEALTH NET (01) | CT |
1388455 | (05) | CT |
2372975 | AETNA US HEALTHCARE (01) | CT |
810160110 | PHCS (01) | CT |
830396 | UNITED HEALTHCARE (01) | CT |
8897122 | CIGNA (01) | CT |
AS1058 | OXFORD (01) | CT |
E62525 | (02) | CT |
P00230453 | RAILROAD MEDICARE (01) | CT |