Healthcare Provider Details

I. General information

NPI: 1184831547
Provider Name (Legal Business Name): DIANA OKUNIEWSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MANSION ST STE 3D
MARSHALL MI
49068-1167
US

IV. Provider business mailing address

1310 WISCONSIN AVE SUITE 103
GRAND HAVEN MI
49417-2472
US

V. Phone/Fax

Practice location:
  • Phone: 269-558-0702
  • Fax:
Mailing address:
  • Phone: 616-844-4528
  • Fax: 616-847-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL1125376
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2245
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO01107
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: