Provider Demographics
NPI:1447242151
Name:DIAMOND, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1603
Mailing Address - Country:US
Mailing Address - Phone:386-252-1632
Mailing Address - Fax:386-257-5526
Practice Address - Street 1:709 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1603
Practice Address - Country:US
Practice Address - Phone:386-252-1632
Practice Address - Fax:386-257-5526
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0013576207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64350OtherBLUE CROSS/BLUE SHIELD
FL036454100Medicaid
24117Medicare ID - Type Unspecified
FL64350OtherBLUE CROSS/BLUE SHIELD