Healthcare Provider Details

I. General information

NPI: 1275336430
Provider Name (Legal Business Name): DIANA ATTISHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 E 13 MILE RD
WARREN MI
48088-3187
US

IV. Provider business mailing address

14474 SHADYWOOD DR
STERLING HEIGHTS MI
48312-3429
US

V. Phone/Fax

Practice location:
  • Phone: 586-486-5669
  • Fax:
Mailing address:
  • Phone: 248-825-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: