Provider Demographics
NPI:1831198290
Name:DIEHL, JOHN MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:DIEHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:MICHAEL
Other - Last Name:DIEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:851 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2979
Mailing Address - Country:US
Mailing Address - Phone:704-788-1142
Mailing Address - Fax:704-782-7912
Practice Address - Street 1:851 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2979
Practice Address - Country:US
Practice Address - Phone:704-788-1142
Practice Address - Fax:704-782-7912
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831198290OtherNPI
NC8908052Medicaid
NC5390600001Medicare NSC
NC1831198290OtherNPI
NC8908052Medicaid