Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35053776 | OH |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.053776 | OH |
NPI | 1336183011 |
---|---|
Provider Name | Kevin Fred Dieter |
First Address | Cleveland, OH 44110-2602 |
Second Address | Cleveland, OH 44110-2602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0692488 | (05) | OH |
A17366 | (02) |