Provider Demographics
NPI:1447297742
Name:MACDONALD, DIANE MARIE (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:401 W GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2819
Practice Address - Country:US
Practice Address - Phone:517-975-9500
Practice Address - Fax:517-975-9511
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053125207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1447297742Medicaid
MI01004511OtherHEALTHPLUS
MI1014282OtherMCLAREN HEALTH PLAN
MI4711898-10Medicaid
MI4711403-10Medicaid
MI1102911631OtherBCBSM
MI200000005798OtherPHP COMMERCIAL
MI4711913-10Medicaid
MI1447297742Medicaid
MI4711898-10Medicaid
MIF33219Medicare UPIN
MI4711403-10Medicaid