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NPI Code Detail

MEDICARE: DR. DIANA A. PRABLEK MD

MEDICARE:  DR. DIANA A. PRABLEK  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
1207RI0200XInfectious Disease Physician109302MO
2207R00000XInternal Medicine Physician109302MO

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 : 1588689541
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA A. PRABLEK MD
Provider Business Mailing Address
First Line : 850 DEAVER LN
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-7732
Country : US
Telephone Number : 314-941-4896
Fax Number :
Provider Business Practice Location Address
First Line : 4055 VALLEY VIEW LN
Second Line :
City : DALLAS
State : TX
Zip : 75244-5074
Country : US
Telephone Number : 469-466-7420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 11/02/2021

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Directions to “ DR. DIANA A. PRABLEK MD” Practice Location

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