Individual
KEVIN FRED DIETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17876 SAINT CLAIR AVE, CLEVELAND, OH 44110-2602
(216) 383-2222
Mailing address
17876 SAINT CLAIR AVE, CLEVELAND, OH 44110-2602
(216) 383-2222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35053776
OH
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
35.053776
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0692488
—
OH
Enumeration date
06/15/2006
Last updated
05/23/2019
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