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NPI Code Detail

MEDICARE: DIANA MINASIAN STULC M.D.

MEDICARE: DIANA MINASIAN STULC M.D.
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
1207Q00000XFamily Medicine Physician20783MS
2207Q00000XFamily Medicine Physician36090KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225002165
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA MINASIAN STULC M.D.
Provider Business Mailing Address
First Line : 5410 MARYLAND WAY 300
Second Line :
City : BRENTWOOD
State : TN
Zip : 37072-5064
Country : US
Telephone Number : 615-377-5658
Fax Number : 888-241-1404
Provider Business Practice Location Address
First Line : 969 LAKELAND DR
Second Line :
City : JACKSON
State : MS
Zip : 39216-4606
Country : US
Telephone Number : 615-377-5658
Fax Number : 888-241-1404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2006
Last Update Date : 12/21/2009

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Directions to “ DIANA MINASIAN STULC M.D.” Practice Location

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