Provider Demographics
NPI:1700855715
Name:DIAMOND, DONITA KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:DONITA
Middle Name:KAY
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DONITA
Other - Middle Name:KAY
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6300 TWENTY-TWO MILE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317
Mailing Address - Country:US
Mailing Address - Phone:586-739-9090
Mailing Address - Fax:
Practice Address - Street 1:6300 TWENTY-TWO MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317
Practice Address - Country:US
Practice Address - Phone:586-739-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII49107Medicare UPIN