Provider Demographics
NPI:1497795462
Name:GREGORY, DIANNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:E
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:E
Other - Last Name:SONEFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1085 S LINDEN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3421
Mailing Address - Country:US
Mailing Address - Phone:810-732-3240
Mailing Address - Fax:810-230-0280
Practice Address - Street 1:8235 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2441
Practice Address - Country:US
Practice Address - Phone:810-694-9110
Practice Address - Fax:810-695-0343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H85134Medicare UPIN