Provider Demographics
NPI:1497998744
Name:DIAS, KATIE ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ELLEN
Last Name:DIAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:16 W 4TH
Mailing Address - City:GRANT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64456
Mailing Address - Country:US
Mailing Address - Phone:660-564-3322
Mailing Address - Fax:660-564-3324
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STANBERRY
Practice Address - State:MO
Practice Address - Zip Code:64489-1358
Practice Address - Country:US
Practice Address - Phone:660-783-2192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200816196207Q00000X
MO2011007997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine