Provider Demographics
NPI:1346274875
Name:VONSTEIN, DIANE E (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:VONSTEIN
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 1:885 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1098
Mailing Address - Country:US
Mailing Address - Phone:419-294-4991
Mailing Address - Fax:419-209-0278
Practice Address - Street 1:885 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1098
Practice Address - Country:US
Practice Address - Phone:419-294-4991
Practice Address - Fax:419-209-0278
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064725A207X00000X
OK28915207XP3100X
OH35048926207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000550234OtherANTHEM PROVIDER NUMBER
IN200372360Medicaid
OH0559766Medicaid
INP00454888Medicare PIN
INA16465Medicare UPIN
OHH295540Medicare PIN
IN815460RRRRMedicare PIN