Provider Demographics
NPI:1013919695
Name:BOYER, DIANNA L (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:BOYER
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:10701 ALLIANCE DR STE A
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8837
Practice Address - Country:US
Practice Address - Phone:317-856-7083
Practice Address - Fax:317-856-7332
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036057A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200092590Medicaid
IN1033110564OtherGROUP NPI NUMBER
IN100159840Medicaid
IN563420NMedicare Oscar/Certification
IN100159840Medicaid
INM400053115Medicare PIN
IN200092590Medicaid