Provider Demographics
NPI:1891953873
Name:DUGAS, DIANE DOLORES (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:DOLORES
Last Name:DUGAS
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 1:21635 BENTLER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3809
Mailing Address - Country:US
Mailing Address - Phone:248-356-6711
Mailing Address - Fax:248-356-6711
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:MCHC, F6135
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-615-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010905962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry