Provider Demographics
NPI:1639508864
Name:BLASER, DIANE C
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:BLASER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:COTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BHS
Mailing Address - Street 1:830 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2725
Mailing Address - Country:US
Mailing Address - Phone:313-357-2912
Mailing Address - Fax:
Practice Address - Street 1:9315 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1260
Practice Address - Country:US
Practice Address - Phone:313-937-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health