Provider Demographics
NPI:1235230327
Name:DITTO, DANE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:EDWARD
Last Name:DITTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 GENN DRIVE WAMEGO HOSPITAL ASSOCIATION
Mailing Address - Street 2:DBA WAMEGO HEALTH CENTER AND WAMEGO FAMILY CLINIC
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547
Mailing Address - Country:US
Mailing Address - Phone:785-456-2295
Mailing Address - Fax:785-456-6916
Practice Address - Street 1:711 GENN DRIVE WAMEGO HOSPITAL ASSOCIATION
Practice Address - Street 2:DBA WAMEGO HEALTH CENTER AND WAMEGO FAMILY CLINIC
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547
Practice Address - Country:US
Practice Address - Phone:785-539-0800
Practice Address - Fax:785-539-0811
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS424873207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100161150BMedicaid
KS100161150BMedicaid
KSF67470Medicare UPIN
KS4718980001Medicare NSC