Provider Demographics
NPI:1750335097
Name:KERWIN, DIANA R (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:R
Last Name:KERWIN
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 1:8198 WALNUT HILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4316
Mailing Address - Country:US
Mailing Address - Phone:214-345-4449
Mailing Address - Fax:214-345-1238
Practice Address - Street 1:8198 WALNUT HILL LN STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4316
Practice Address - Country:US
Practice Address - Phone:214-345-4449
Practice Address - Fax:214-345-1238
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44447207RG0300X
TXP5658207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34205300Medicaid
006000261ROtherHUMANA
TX326041601Medicaid
0011D73601Medicare ID - Type Unspecified
WI34205300Medicaid
TX295324YKQLMedicare PIN