Provider Demographics
NPI:1013065192
Name:DIEHL, DAVID JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:DIEHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 WOODLAND DRIVE EAST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1682
Mailing Address - Country:US
Mailing Address - Phone:734-944-3820
Mailing Address - Fax:734-944-9250
Practice Address - Street 1:760 WOODLAND DRIVE EAST
Practice Address - Street 2:SUITE 3
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1682
Practice Address - Country:US
Practice Address - Phone:734-944-3820
Practice Address - Fax:734-944-9250
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010652212084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
104548OtherCARE CHOICES
104548OtherPREFERRED CHOICES
MI2608111011OtherBLUE CROSS BLUE SHIELD
F71164Medicare UPIN
0M15780Medicare ID - Type Unspecified