Provider Demographics
NPI:1962462887
Name:SOULIAS, DIANA C (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:C
Last Name:SOULIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23800 ORCHARD LAKE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2561
Mailing Address - Country:US
Mailing Address - Phone:248-476-2420
Mailing Address - Fax:248-476-9709
Practice Address - Street 1:23800 ORCHARD LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2561
Practice Address - Country:US
Practice Address - Phone:248-476-2420
Practice Address - Fax:248-476-9709
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS055904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080062245OtherMEDICARE RAILROAD
C3313OtherMCARE
MI0634321OtherBCBS
103514OtherCARE CHOICES PREFERRED CH
MI2951760Medicaid
MI0M10880006Medicare ID - Type Unspecified
MI080062245OtherMEDICARE RAILROAD