Provider Demographics
NPI:1033182126
Name:DIETRICH, CASSIE CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:CHRISTINE
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:DIETRICH
Other - Last Name:VOLKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8717 W 110TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-428-2900
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:8717 W 110TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2144
Practice Address - Country:US
Practice Address - Phone:913-428-2900
Practice Address - Fax:913-428-2951
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37567207L00000X
MO2014033205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN181653500Medicaid
MNP00427427OtherRAILROAD MEDICARE
MN050002015Medicare PIN
MNP00427427OtherRAILROAD MEDICARE