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Individual

DIANE M VISICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
211 S CRAPO ST, SUITE A, MOUNT PLEASANT, MI 48858-2961
(989) 775-3823
(989) 773-5061
Mailing address
PO BOX 994, ALMA, MI 48801-0994
(989) 775-7641
(989) 775-6472

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003226
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0853701290
BCBSM
MI
Enumeration date
07/04/2006
Last updated
08/07/2008
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