MEDICARE: DR. DIANA C FU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	01055280A	IN
2	208VP0000X	Pain Medicine Physician	01055280A	IN
3	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	01055280A	IN

General Provider Information

NPI Number	:	1174682652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA C FU MD

Provider Business Mailing Address
First Line	:	PSC 475 BOX 1
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96350-1200
Country	:	US
Telephone Number	:	46-816-5153
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 475
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96350-9998
Country	:	US
Telephone Number	:	46-816-5153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	02/06/2025

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