Healthcare Provider Details

I. General information

NPI: 1205912193
Provider Name (Legal Business Name): MICHAEL DIAMOND DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 UNIVERSITY PKWY
UNIVERSITY HEIGHTS OH
44118-3928
US

IV. Provider business mailing address

4501 UNIVERSITY PKWY
UNIVERSITY HEIGHTS OH
44118-3928
US

V. Phone/Fax

Practice location:
  • Phone: 216-401-6558
  • Fax: 216-932-9499
Mailing address:
  • Phone: 216-401-6558
  • Fax: 216-932-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: