Provider Demographics
NPI:1972593986
Name:DILTZ, EMILY (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:DILTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 103 B
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5782
Mailing Address - Country:US
Mailing Address - Phone:865-803-6043
Mailing Address - Fax:865-539-5936
Practice Address - Street 1:460 MEDICAL PARK DR
Practice Address - Street 2:SUITE 103 B
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5782
Practice Address - Country:US
Practice Address - Phone:865-803-6043
Practice Address - Fax:865-539-5936
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27616207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3098146Medicare PIN
TNB47996Medicare UPIN
P00039685Medicare PIN
TN3734041Medicare PIN