Provider Demographics
NPI:1679530760
Name:CROOK, DIANA R (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:R
Last Name:CROOK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8020 E CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2360
Mailing Address - Country:US
Mailing Address - Phone:316-636-2662
Mailing Address - Fax:316-636-2644
Practice Address - Street 1:8020 E CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2360
Practice Address - Country:US
Practice Address - Phone:316-636-2662
Practice Address - Fax:316-636-2644
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-01-14
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Provider Licenses
StateLicense IDTaxonomies
KS0423525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2050480301Medicaid
KS2050480301Medicaid
KSE54599Medicare UPIN