Provider Demographics
NPI:1356439582
Name:HALLINEN, DIANE L (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:HALLINEN
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 1:422 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2404
Mailing Address - Country:US
Mailing Address - Phone:810-496-5777
Mailing Address - Fax:810-496-5798
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-257-9429
Practice Address - Fax:810-257-9104
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059413207PE0004X
MISA0250385193200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193200000XGroupMulti-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B51090OtherBLUE SHIELD
MI3427485Medicaid
MI3427485Medicaid
MI0B51090OtherBLUE SHIELD