Provider Demographics
NPI:1649240573
Name:SACCHETTI, DIANE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LOUISE
Last Name:SACCHETTI
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 1:1611 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS048409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1527634OtherUMWA HEALTH FUND
MI110H220280OtherBCN
MI110H233050OtherBCBS OF MICHIGAN
MI5249124OtherAETNA
MI700H219330OtherBCBSM
110018813OtherRAILROAD MEDICARE
MIN57270004Medicare ID - Type Unspecified
MI1527634OtherUMWA HEALTH FUND
110018813OtherRAILROAD MEDICARE