Provider Demographics
NPI:1265441737
Name:WILSHER, DIANA (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:WILSHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36659 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1640 FORT ST
Practice Address - Street 2:SUITE D
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2040
Practice Address - Country:US
Practice Address - Phone:734-671-6741
Practice Address - Fax:734-671-1038
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH35195Medicare UPIN