Individual
DR. PAUL G DIEDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10787 NALL AVE, STE. 310, OVERLAND PARK, KS 66211-1375
(913) 945-6900
(913) 945-6970
Mailing address
2330 SHAWNEE MISSION PARKWAY, MEDICAL ADMINISTRATIVE SERVICES OF KU STE. 312, WESTWOOD, KS 66205-0000
(913) 945-5614
(913) 945-5617
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-33478
KS
207R00000X
Internal Medicine Physician
R9699
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DI201088119
—
MO
Enumeration date
01/18/2006
Last updated
06/16/2009
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