MEDICARE: DR. DIANA MARIE FLIS 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
1	208200000X	Plastic Surgery Physician	4301098769	MI

General Provider Information

NPI Number	:	1972890085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA MARIE FLIS M.D.

Provider Business Mailing Address
First Line	:	6830 PRICE LAKE RD N
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8013
Country	:	US
Telephone Number	:	313-300-9630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 SPRING ARBOR RD STE 200
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3995
Country	:	US
Telephone Number	:	517-205-2107
Fax Number	:

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

Provider Enumeration Date	:	07/09/2011
Last Update Date	:	02/28/2019

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