Healthcare Provider Details

I. General information

NPI: 1093713703
Provider Name (Legal Business Name): CINDY L KIRBY-DIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W R D MIZE RD SUITE 304
BLUE SPRINGS MO
64014-2518
US

IV. Provider business mailing address

205 W R D MIZE RD SUITE 304
BLUE SPRINGS MO
64014-2518
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-4770
  • Fax: 816-228-1156
Mailing address:
  • Phone: 816-228-4770
  • Fax: 816-228-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200102696
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier049924
Identifier TypeOTHER
Identifier State
Identifier IssuerFAMILY HEALTH PARTNERS
# 2
Identifier049993
Identifier TypeOTHER
Identifier State
Identifier IssuerFAMILY HEALTH PARTNERS
# 3
Identifier209232222
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 4
Identifier33514022
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS/BLUE SHIELD
# 5
Identifier1201847
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTH CARE
# 6
Identifier7354357
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 7
Identifier502062
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST GUARD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: