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General NPI Number Information
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NPI Number | 1336589035
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Entity Type | Individual
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Provider Name | MARK DIAMOND M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 319 STRAWBERRY DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4944
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Country | US
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Telephone | 973-985-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 319 STRAWBERRY DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4944
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Country | US
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Telephone | 973-985-5570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 10801
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301512337
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License Number State | MI
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