Dr Glenn J Kietzer, MD | |
15005 Pacific Ave, Spanaway General Medical, Tacoma, WA 98444 | |
(253) 537-3724 | |
(253) 537-6425 |
Full Name | Dr Glenn J Kietzer |
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Gender | Male |
Speciality | General Practice |
Location | 15005 Pacific Ave, Tacoma, Washington |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003847179 | NPI | - | NPPES |
1195601 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | MD00009584 (Washington) | Primary |
Entity Name | Northwestern Healthcare Management Services, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1457873002 PECOS PAC ID: 2365715026 Enrollment ID: O20170831003358 |
Mailing Address | Practice Location Address |
---|---|
Dr Glenn J Kietzer, MD 15005 Pacific Ave, Spanaway General Medical, Tacoma, WA 98444 Ph: (253) 537-3724 | Dr Glenn J Kietzer, MD 15005 Pacific Ave, Spanaway General Medical, Tacoma, WA 98444 Ph: (253) 537-3724 |
Molly Cunard, General Practice Medicare: Medicare Enrolled Practice Location: 9040 Jackson Ave, Tacoma, WA 98431 Phone: 253-968-0117 | |
Courtney Lavin, General Practice Medicare: Medicare Enrolled Practice Location: 9040 Jackson Ave, Tacoma, WA 98431 Phone: 253-968-1790 | |
Desislava Zlatanova Hite, M.D. General Practice Medicare: Accepting Medicare Assignments Practice Location: 315 Martin Luther King Jr Way, Tacoma, WA 98405 Phone: 253-403-8327 | |
Michael A. Bork, DO General Practice Medicare: Not Enrolled in Medicare Practice Location: Madigan Army Medical Center 9040 Jackson Ave, Tacoma, WA 98431 Phone: 253-968-2462 Fax: 253-968-2972 | |
Jessica Lynne Lewis-cruz, MD General Practice Medicare: Not Enrolled in Medicare Practice Location: 9040 Jackson Ave, Tacoma, WA 98431 Phone: 253-968-0117 | |
Sean Egan, General Practice Medicare: Medicare Enrolled Practice Location: 9040 Jackson Ave, Tacoma, WA 98431 Phone: 253-968-1250 |