Healthcare Provider Details

I. General information

NPI: 1952388563
Provider Name (Legal Business Name): DIANE L PARRETT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6207 HARVEY ST STE A
NORTON SHORES MI
49444-7861
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-2230
  • Fax: 231-672-2231
Mailing address:
  • Phone: 231-727-4444
  • Fax: 231-728-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101012829
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: