Healthcare Provider Details

I. General information

NPI: 1295244283
Provider Name (Legal Business Name): DIANA ELIZABETH FLAHARTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA ELIZABETH FLORES PA-C

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4967 CROOKS RD STE 100
TROY MI
48098-5812
US

IV. Provider business mailing address

26211 CENTRAL PARK BLVD STE 201
SOUTHFIELD MI
48076-4158
US

V. Phone/Fax

Practice location:
  • Phone: 248-846-8060
  • Fax: 248-590-2063
Mailing address:
  • Phone: 248-845-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008410
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: