Provider Demographics
NPI:1336147867
Name:LITKE, DIANE SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:SUE
Last Name:LITKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 830398
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-0398
Mailing Address - Country:US
Mailing Address - Phone:972-498-4791
Mailing Address - Fax:972-498-4939
Practice Address - Street 1:403 W CAMPBELL RD
Practice Address - Street 2:STE 320
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3466
Practice Address - Country:US
Practice Address - Phone:972-498-4791
Practice Address - Fax:972-498-4939
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4128207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200038687OtherRAILROAD MEDICARE
TX8119303003OtherCIGNA
TX8558K0OtherBCBS OF TX
TX096653303Medicaid
TX1769656OtherUNITED HEALTH CARE
TX4154179OtherBLUE LINK
TX5962564OtherAETNA
TX5962564OtherAETNA
TX8558K0Medicare ID - Type Unspecified