Provider Demographics
NPI:1679681282
Name:KREPTOWSKI, DIANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:
Last Name:KREPTOWSKI
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 1:6509 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7265
Mailing Address - Country:US
Mailing Address - Phone:330-244-0480
Mailing Address - Fax:330-244-2230
Practice Address - Street 1:6509 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7265
Practice Address - Country:US
Practice Address - Phone:330-244-0480
Practice Address - Fax:330-244-2230
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6419K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2059294Medicaid
OH2059294Medicaid
OH2059294Medicaid