Provider Demographics
NPI:1831181254
Name:DARK, DIANA S (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:S
Last Name:DARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 65
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-932-6100
Practice Address - Fax:816-932-9002
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101915207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16884Medicare UPIN
MOW195438Medicare PIN
F065438Medicare ID - Type Unspecified
KS10013526013Medicaid
D16884Medicare UPIN
KS100135260CMedicaid
MOW195438Medicare PIN
F065438Medicare ID - Type Unspecified
MO202109815Medicaid