Healthcare Provider Details

I. General information

NPI: 1518437805
Provider Name (Legal Business Name): DIAMOND MARIE MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19334 W 7 MILE RD
DETROIT MI
48219-2756
US

IV. Provider business mailing address

12146 KENTUCKY ST
DETROIT MI
48204-1089
US

V. Phone/Fax

Practice location:
  • Phone: 313-314-8555
  • Fax:
Mailing address:
  • Phone: 313-412-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: