MEDICARE: DIANE L BARANOWSKI 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	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	4301051685	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0H26340	OTHER	MI	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750359204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE L BARANOWSKI MD

Provider Business Mailing Address
First Line	:	19855 OUTER DR
Second Line	:	STE 204
City	:	DEARBORN
State	:	MI
Zip	:	48124-2022
Country	:	US
Telephone Number	:	313-565-3565
Fax Number	:	313-565-7723

Provider Business Practice Location Address
First Line	:	19855 OUTER DR
Second Line	:	STE 204
City	:	DEARBORN
State	:	MI
Zip	:	48124-2022
Country	:	US
Telephone Number	:	313-565-3565
Fax Number	:	313-565-7723

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	06/22/2015

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