Provider Demographics
NPI:1902896731
Name:DIORA, GORDHAN G (MD)
Entity Type:Individual
Prefix:
First Name:GORDHAN
Middle Name:G
Last Name:DIORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8244 METROPOLITAN PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2778
Mailing Address - Country:US
Mailing Address - Phone:586-795-4060
Mailing Address - Fax:586-795-5595
Practice Address - Street 1:8244 METROPOLITAN PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2778
Practice Address - Country:US
Practice Address - Phone:586-795-4060
Practice Address - Fax:586-795-5595
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4559756Medicaid
MIN78540005Medicare ID - Type Unspecified
MI4559756Medicaid