Provider Demographics
NPI:1548263395
Name:PARSONS, DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:PARSONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SIXTH ST
Mailing Address - Street 2:ATTN: HOME CARE
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2349
Mailing Address - Country:US
Mailing Address - Phone:231-935-6520
Mailing Address - Fax:231-935-9116
Practice Address - Street 1:1105 SIXTH ST
Practice Address - Street 2:ATTN: HOME CARE
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2349
Practice Address - Country:US
Practice Address - Phone:231-935-6520
Practice Address - Fax:231-935-9116
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405328174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP24420007OtherMEDICARE PART B - WPS
MI0281046OtherBCBS#
MI4301405328OtherSTATE LICENSE #
MI4618418Medicaid
MIP24420007OtherMEDICARE PART B - WPS
MI0N95950Medicare PIN