Provider Demographics
NPI:1134198054
Name:DIETER, MICHAEL A (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:DIETER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2756
Practice Address - Country:US
Practice Address - Phone:509-344-8672
Practice Address - Fax:509-747-7838
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA379109600OtherOWCP
WA8387292Medicaid
WA970027249OtherRR MEDICARE
ID806174800Medicaid
WA8934606OtherCRIME VICTIMS
WA4305DIOtherASURIS NW HEALTH
IDK6401OtherBLUE CROSS OF ID
ID000010149524OtherREGENCE BLUE SHIELD OF ID
WA0156193OtherDEPT OF LABOR & INDUSTRIE
WA5847OtherGROUP HEALTH NW