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NPI Code Detail

MEDICARE: DR. CRAIG ALLAN DIETZ D.O.

MEDICARE: DR. CRAIG ALLAN DIETZ D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician2003024389MO

General Provider Information

NPI Number : 1740247097
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRAIG ALLAN DIETZ D.O.
Provider Business Mailing Address
First Line : 3515 BROADWAY BLVD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-2501
Country : US
Telephone Number : 816-777-2759
Fax Number : 816-753-0804
Provider Business Practice Location Address
First Line : 3515 BROADWAY ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-2537
Country : US
Telephone Number : 816-777-2759
Fax Number : 816-753-0804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 06/23/2023

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