Provider Demographics
NPI:1366461212
Name:DONLEY, DIANE K (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:K
Last Name:DONLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10262 S WESTERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6852
Mailing Address - Country:US
Mailing Address - Phone:231-922-0797
Mailing Address - Fax:
Practice Address - Street 1:110 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2340
Practice Address - Country:US
Practice Address - Phone:231-935-0340
Practice Address - Fax:231-935-0343
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDD0624782084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA63221Medicare UPIN