Provider Demographics
NPI:1972267128
Name:DIETZ, ALBERT JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOSEPH
Last Name:DIETZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W651 WEST CT
Mailing Address - Street 2:
Mailing Address - City:GENOA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53128-1124
Mailing Address - Country:US
Mailing Address - Phone:262-279-0722
Mailing Address - Fax:
Practice Address - Street 1:W651 WEST CT
Practice Address - Street 2:
Practice Address - City:GENOA CITY
Practice Address - State:WI
Practice Address - Zip Code:53128-1124
Practice Address - Country:US
Practice Address - Phone:262-279-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39310-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine