Individual
JOHN L DIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
560 W MITCHELL ST, PETOSKEY, MI 49770-2278
(231) 487-2460
(231) 487-6596
Mailing address
560 W MITCHELL ST, PETOSKEY, MI 49770-2278
(231) 487-2460
(231) 487-6596
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301044782
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104085688
—
MI
Enumeration date
06/30/2005
Last updated
07/08/2007
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