Provider Demographics
NPI:1225022387
Name:DIOLA, CARLOS (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:DIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 N CAMPUS RIDGE DR
Mailing Address - Street 2:STE C2100
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6112
Mailing Address - Country:US
Mailing Address - Phone:989-837-9033
Mailing Address - Fax:989-837-9030
Practice Address - Street 1:4401 N CAMPUS RIDGE DR
Practice Address - Street 2:STE C2100
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6112
Practice Address - Country:US
Practice Address - Phone:989-837-9033
Practice Address - Fax:989-837-9030
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077266207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4568334Medicaid
MI4568334Medicaid
MIG07572Medicare UPIN