Provider Demographics
NPI:1376564005
Name:HARPER, DIANE MEDVED (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MEDVED
Last Name:HARPER
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 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:7300 DEXTER-ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-8598
Practice Address - Country:US
Practice Address - Phone:734-426-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46829207VG0400X, 207Q00000X
MI4301114011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00029147OtherVT BCBS
AA71454OtherHARVARD PILGRIM
0912001OtherCIGNA
VT0RE4240Medicaid
0102841YPNH03OtherANTHEM BCBS
NH30009968Medicaid
0102841YPNH03OtherANTHEM BCBS
0912001OtherCIGNA