Provider Demographics
NPI:1760009070
Name:PAMILA DIWAN, MD
Entity Type:Organization
Organization Name:PAMILA DIWAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-644-8220
Mailing Address - Street 1:30555 SOUTHFIELD RD STE 180
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7700
Mailing Address - Country:US
Mailing Address - Phone:248-644-8220
Mailing Address - Fax:248-644-7338
Practice Address - Street 1:30555 SOUTHFIELD RD STE 180
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7700
Practice Address - Country:US
Practice Address - Phone:248-644-8220
Practice Address - Fax:248-644-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1192OtherOBGYN
MI1831172303Medicaid