Healthcare Provider Details

I. General information

NPI: 1831198290
Provider Name (Legal Business Name): JOHN MICHAEL DIEHL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN MICHAEL DIEHL DPM

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 BRADLEY ST
CONCORD NC
28025-2979
US

IV. Provider business mailing address

851 BRADLEY ST
CONCORD NC
28025-2979
US

V. Phone/Fax

Practice location:
  • Phone: 704-788-1142
  • Fax: 704-782-7912
Mailing address:
  • Phone: 704-788-1142
  • Fax: 704-782-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number150
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: