Provider Demographics
NPI:1184316077
Name:DIEHL, MICHAEL TODD (PSS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:DIEHL
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:TODD
Other - Last Name:DIEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSS
Mailing Address - Street 1:1215 SW G ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2544
Mailing Address - Country:US
Mailing Address - Phone:541-476-2373
Mailing Address - Fax:
Practice Address - Street 1:109 NE MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1400
Practice Address - Country:US
Practice Address - Phone:541-476-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist