Provider Demographics
NPI:1457111932
Name:GILLIAM, DIAMOND E
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:E
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14703 LAPPIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-0900
Mailing Address - Country:US
Mailing Address - Phone:313-737-8890
Mailing Address - Fax:
Practice Address - Street 1:14703 LAPPIN ST APT B
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-0900
Practice Address - Country:US
Practice Address - Phone:313-737-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health