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NPI Code Detail

MEDICARE: KEVIN FRED DIETER MD

MEDICARE: KEVIN FRED DIETER MD
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
1207Q00000XFamily Medicine Physician35053776OH
2207QH0002XHospice and Palliative Medicine (Family Medicine) Physician35.053776OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336183011
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN FRED DIETER MD
Provider Business Mailing Address
First Line : 17876 SAINT CLAIR AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44110-2602
Country : US
Telephone Number : 216-383-2222
Fax Number :
Provider Business Practice Location Address
First Line : 17876 SAINT CLAIR AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44110-2602
Country : US
Telephone Number : 216-383-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 05/23/2019

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Directions to “ KEVIN FRED DIETER MD” Practice Location

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