Provider Demographics
NPI:1437337508
Name:DIANE L SACCHETTI MD PC
Entity Type:Organization
Organization Name:DIANE L SACCHETTI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SACCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-278-7100
Mailing Address - Street 1:1611 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2912
Mailing Address - Country:US
Mailing Address - Phone:313-278-7100
Mailing Address - Fax:313-562-2216
Practice Address - Street 1:1611 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2912
Practice Address - Country:US
Practice Address - Phone:313-278-7100
Practice Address - Fax:313-562-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS048409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110018813OtherRAILROAD MEDICARE
110H233050OtherBCBS OF MI
0P53050Medicare PIN
110018813OtherRAILROAD MEDICARE