Provider Demographics
NPI:1750860334
Name:DIERKER PHYSICIANS LLC
Entity Type:Organization
Organization Name:DIERKER PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:FITKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-949-4957
Mailing Address - Street 1:1733 ARDLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1401
Mailing Address - Country:US
Mailing Address - Phone:614-949-4957
Mailing Address - Fax:
Practice Address - Street 1:1733 ARDLEIGH RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1401
Practice Address - Country:US
Practice Address - Phone:614-949-4957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.072294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty