Provider Demographics
NPI:1922304138
Name:DIENER, JANSEN CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:JANSEN
Middle Name:CRAIG
Last Name:DIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:NCT 20
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2946
Mailing Address - Country:US
Mailing Address - Phone:502-580-4070
Mailing Address - Fax:502-508-4070
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:NCT 20
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2946
Practice Address - Country:US
Practice Address - Phone:502-580-4070
Practice Address - Fax:502-508-4070
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01065419A207Q00000X
KY23832207Q00000X
VA0101244204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine