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General NPI Number Information
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NPI Number | 1871116509
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Entity Type | Individual
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Provider Name | ANTHONY DIEBES MD
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD BLDG 4TH
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 715-894-0122
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Fax |
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Provider Business Mailing Address
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Address Line | 685 SCOBIE LN
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City | EAU CLAIRE
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State | WI
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Zip | 54703-2193
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Country | US
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Telephone | 715-894-0122
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4351046851
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License Number State | MI
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